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http://www.archive.org/details/carefeedingofchi1917holt 


THE  CARE  AND  FEEDING 
OF  CHILDREN 


THE  CARE  AND  FEEDING 
OF  CHILDREN 

A   CATECHISM    FOR   THE    USE    OF    MOTHERS 
AND    CHILDREN'S    NURSES 


BY 

L.   EMMETT  HOLT,   M.D.,  LL.D. 

PROFESSOR   OF  DISEASES   OF  CHILDREN  IN  THE   COLLEGE   OF  PHYSICIANS 

AND   SURGEONS   (COLUMBIA   UNIVERSITY) 

ATTENDING   PHYSICIAN  TO  THE   BABIES'   HOSPITAL  AND  THE 

FOUNDLING  HOSPITAL,   NEW   YORK 


(Cigiitf)  Cbition,  3R.Ebigeb  anb  Cnlargeb 


NEW   YORK   AND    LONDON 

D.  APPLETON   AND   COMPANY 
1917 


CoPTBiGHT,  1894,  1897,  1903,  1906,  1909,  1912,  1914,  1915,  bt 
D.  APPLETON  AND  COMPANY 


Printed  in  the  United  States  of  America 


TO 
THE  YOUNG  MOTHERS  OF  AMERICA, 

TOWARD  THE  SOLUTION  OF  WHOSE  PROBLEMS 
THESE  PAGES  HAVE  BEEN  DEVOTED, 

THIS    WORK 

IS     RESPECTFULLY     DEDICATED 

BY  THE  AUTHOR. 


PREFACE  TO  THE  EIGHTH  EDITION 


The  constant  use  of  the  Catechism  as  a  manual 
for  nursery  maids  has  shown  the  need  of  fuller  treat- 
ment of  several  subjects  than  was  given  in  the  earlier 
editions.  An  attempt  has  been  made  to  meet  the 
needs  of  mothers  and  nurses  outside  of  institutions 
who  have  made  the  book  a  nursery  guide,  especially 
in  matters  relating  to  older  children. 

The  author's  aim  has  been  not  to  alarm  the  mother 
by  acquainting  her  with  all  the  possible  diseases  and 
accidents  which  may  befall  her  child,  but  to  open 
her  eyes  to  matters  which  are  her  direct  and  chief 
concern. 

It  is,  therefore,  the  needs  of  the  well  child,  not 
the  sick  one,  which  have  been  considered.  The  well 
child  must,  in  most  cases,  be  left  to  the  care  of  the 
mother  or  nurse  for  whose  guidance  and  assistance 
these  pages  are  intended.  For  directions  in  matters 
of  illness,  however,  no  mother  or  nurse  should  de- 

7 


8        THE  CARE  AND  FEEDING  OF  CHILDREN 

pend  upon  any  manual,  but  upon  the  advice  of  a 
physician. 

It  is  hoped  that  the  mothers  and  nurses  who  have 
found  the  earlier  editions  of  the  Catechism  helpful 
in  the  solution  of  some  of  their  nursery  problems 
will  find  even  greater  assistance  from  the  present 
volume. 

New  York    1915 


CONTENTS 


THE  CARE  OF  CHILDREN 

FAOB 

Bathing .        .       .       .        .  15 

Genital  organs 16 

Eyes      .        .        .        .        .        .    :    .        .        .        .        .        .  17 

Mouth 18 

Skin 19 

Clothing 21 

Napkins 24 

Nursery        ...........  25 

Airing 27 

Weight,  growth,  and  deveicpment  .        .        .       .        .        .  31 

Dentition 37 


II 
INFANT  FEEDING 

Nursing 44 

Weaning  from  the  breast  .        . 53 

Weaning  from  the  bottle 55 

Artificial  feeding 58 

Selection  and  care  of  milk  used  for  infant  feeding        .       .  58 

Modification  of  cow's  milk 63 

Cream,  67;  top  milk,  68. 

9 


V 


10  THE  CAEE  AND  FEEDING  OF  CHILDEEN 

PAGE 

Food  for  healthy  infants 69 

Formulas    from    whole    milk,    73;    formulas    from 
7-per-cent  milk,  75. 

Intervals  of  feeding 76' 

Schedule  of  quantities  and  intervals  for  first  year        .        .77 

Preparation  of  milk  at  home 79 

Directions  for  feeding 82: 

General  rules  for  guidance  in  feeding 84 

How  to  begin,  84;  increasing  the  food,  85;  reducing 
the  food,  88. 

Regularity  in  feeding         .        .        .        .        .        .        .        .  90 

Overfeeding 91 

Common  mistakes  in  infant  feeding 93 

Changes  in  food  required  by  special  sjTnptoms     ...  94 
Loss  of  appetite,  94;  vomiting,  95;  cohc,  98;  constipa- 
tion, 99;  hot  weather,  100;  no  gain  in  weight,  100; 
use  of  condensed  milk,  102;  slight  indisposition,  103; 
acute  illness,  103;  diarrhoea,  104. 

Addition  of  other  food 105^ 

Use  of  fruit  juices,  105;  beef  juice,  106;  broths,  107; 
eggs,  107;  toast  and  crackers,  107. 

Substitutes  for  fresh  milk          .        .        .        .        .        .        .  108 

Sterilized  milk     .        .        .        .        .        .        .        .       .        .109 

Pasteurized  milk 110 

Modified  milk  from  the  milk  laboratories      .        .        .        .114 

Frozen  milk         . 115 

Beptonized  milk  .        .        .       .        ....        .        .        .  116' 

Condensed  milk ,        ,        .  116 

Buttermilk 119 

Casein  or  protein  milk ,        .  119 

Feeding  during  the  second  year 121 

Schedule  for  tweKth  to  fifteenth  month          .        .        .        .  122 

Schedule  for  fourteenth  to  eighteenth  month        .        .        .  123 


CONTENTS  11 


PAGE 

Schedule  for  eighteenth  to  twenty-fourth  month  .        .        .     124 
Fee'difig  during  the  third  year 126 

III 

THE  DIET  OF  OLDER  CHILDREN 

Milk  and  cream 131 

Eggs 133 

Meats  and  fish 134 

Vegetables •       .     135 

Cereals .     137 

Broths  and  soups 138 

Bread,  crackers,  and  cakes 139 

Desserts 139 

Fruits 141 

Indigestion  in  older  children 143 

Acute  indigestion,  143;  chronic  indigestion,  145. 

General  rules  to  be  observed  in  feeding 147 

Food  formulas 150 

Beef  juice,  150;  mutton  broth,  151;  chicken,  veal,  and 
beef  broths,  151;  scraped  beef  or  meat  pulp,  152; 
junket  curds,  and  whey,  152;  barley  water,  152;  bar- 
ley jelly,  153;  rice,  wheat,  oat  water,  153;  oat,  wheat, 
rice  jelly,  154;  albumin  water,  154;  hme-water,  154; 
dried  bread,  155;  coddled  egg,  155. 

IV 

MISCELLANEOUS 

Bowels ...       .     160 

Sleep 161 

Causes  of  disturbed  sleep .     163 


12  THE  CARE  AKD  FEEDING  OF  CHILDEEN 

PAGE 

Exercise 165 

Cry        . 166 

Lifting  children   .        .        .- 168 

Temperatm-e        . 169 

Nervousness         .        . 171 

Playing  with  babies 171 

Toys 172 

Kissing 174 

Convulsions 174 

Foreign  bodies  swallowed 175 

Foreign  bodies  in  the  ear 177 

Foreign  bodies  in  the  nose 177 

CoHc 177 

Earache 178 

Croup 179 

Contagious  diseases • .        .        .        .  180 

Measles,  180;  German  measles,  181;  scarlet  fever, 
181;  whooping  cough,  182;  chicken  pox,  182;  diph- 
theria, 182;  mumps,  183. 

Treatment  for  commencing  illness 184 

Nursery  training  to  help  the  doctor 185 

Scurvy 185 

Constipation 187 

Diarrhoea 189 

Bad  habits 190 

Vaccination          ..........  194 

Adenoids ^     .       .       .        .  195 

Enlarged  tonsils 197 

Weight  charts 199,  200 

Index 203 


PART  I 
THE  CARE  OF  CHILDREN 


THE   CARE   AND   FEEDING   OP 
CHILDREN 


THE  GARE   OF  CHILDREN 

BATHING 

At  wJiat  age  may  a  child  he  given  a  full  tub  hath  f 
Usually  when  ten   days   old;   it  should   not   be 
given  before  the  cord  has  come^  off. 

How  should  the  hath  he  given? 

It  should  not  be  given  sooner  than  one  hour  after 
feeding.  The  room  should  be  warm;  if  possible 
there  should  be  an  open  fire.  The  head  and  face 
should  first  be  washed  and  dried;  then  the  body 
should  be  soaped  and  the  infant  placed  in  the  tub 
with  its  body  well  supported  by  the  hand  of  the 
nurse.  The  bath  should  be  given  quickly,  and  the 
body  dried  rapidly  with  a  soft  towel,  but  with  very 
little  rubbing. 

At  what  temperature  should  the  hath  he  given? 
"For  the  first  few  weeks  at  100°  F. ;  later,  dur- 

15 


16         THE    CAEE   AND    FEEDING   OF   CHILDEEN 

ing  early  infancy,  at  98°  F. ;  after  six  months,  at 
95°  F. ;  during  the  second  year,  from  85°  to  90°  F. 

With  what  should  the  hath  he  given? 

Soft  sponges  are  useful  for  bathing  the  body, 
limbs  and  scalp.  There  should  be  a  separate  wash- 
cloth'for  the  face  and  another  for  the  buttocks. 

What  are  the  ohjections  to  hath  sponges? 

When  used  frequently,  they  become  very  dirty 
and  are  liable  to  cause  infection  of  the  eyes,  mouth, 
or  genital  organs. 

Under  luhat  circumstances  should  the  daily  tub 
hath  he  omitted? 

In  the  case  of  very  feeble  or  delicate  infants  on 
account  of  the  exjDosure  and  fatigue,  and  in  all  forms 
of  acute  illness  except  by  direction  of  the  physician. 
In  eczema  and  many  other  forms  of  skin  disease 
much  harm  is  often  done  by  bathing  with  soap  and 
water,  or  even  with  water  alone. 

GENITAL  OEGAK'S 

How  should  the  genital  organs  of  a  female  child 
he  cleansed? 

Best  with  fresh  absorbent  cotton  and  tepid  water, 
or  a  solution  of  boric  acid,  two  teaspoonfuls  to  the 
pint.     This  should  be  done  carefully  at  least  once  a 


EYES  17 

day.  If  any  discharge  is  present,  the  boric-acid  so- 
lution should  invariably  be  used  twice  a  day.  Great 
care  is  necessary  at  all  times  to  prevent  infection 
which  often  arises  from  soiled  napkins. 

How  should  the  genital  organs  of  a  male  child 
he  cleansed? 

In  infancy  and  early  childhood  the  foreskin 
.?;hould  be  pushed  completely  back  at  least  twice  a 
week  while  the  child  is  in  his  bath,  and  the  parts 
thus  exposed  washed  gently  with  absorbent  cotton 
and  water,  afterwards  drawn  forward  again. 

If  the  foreskin  is  tightly  adherent  and  cannot 
readily  be  pushed  back,  the  physician's  attention 
should  be  called  to  it.  The  nurse  or  mother  should 
not  attempt  forcible  stretching. 

When  is  circumcision  advisable? 

Usually,  when  the  foreskin  is  very  long  and  so 
tight  that  it  cannot  be  pushed  back  without  iov^ie; 
always,  when  this  condition  is  accompanied  by  eii- 
dences  of  local  irritation  or  difficulty  in  passing 
water. 

EYES 

How  should  the  eyes  of  a  little  hahy  he  cleansed? 
With  a  piece  of  soft  linen  or  absorbent  cotton 


18         THE    CAEE    AXD    FEEDING   OF   CHILDEEN 


and  a  lukewarm  solution  of  salt  or  boric  acid, — one 
even  teaspoonful  to  one  pint  of  water. 

//  pus  appears  in  the  eyes,  ivJiat  should  he 
done? 

Thej  should  be  cleansed  every  hour  witb  a  solu- 
tion of  boric  acid  (ten  grains  to  one  ounce  of  water). 
If  the  lids  stick  together,  a  little  vaseline  from  a  tube 
should  be  rubbed  upon  them  at  night.  If  the  trouble 
is  slight,  this  treatment  will  control  it ;  if  it  is  severe, 
a  physician  should  be  called  immediately,  as  delay 
may  result  in  loss  of  eyesight. 

MOUTH 

How  is  an  infant's  mouth  to  he  cleansed  f 
An  excellent  method  is  by  the  use  of  a  swab  made 
by  twisting  a  bit  of  absorbent  cotton  upon  a  wooden 
toothpick.  With  this  the  folds  between  the  gums  and 
lips  and  cheeks  may  be  gently  and  carefully  cleansed 
twice  a  day  unless  the  mouth  is  sore.  It  is  not  neces- 
sary after  every  feeding.  The  finger  of  the  nurse, 
often  employed,  is  too  large  and  liable  to  injure  the 
delicate  mucous  membrane. 

What  is  sprue  ? 

It  appears  on  the  lips  and  inside  the  cheeks  like 
little  white  threads  or  flakes.    It  is  also  called  thrusL 


SKIN  19' 

In']3ad  cases  it  may  cover  the  tongue  and  the  whole 
of  the  inside  of  the  mouth. 

How  should  a  mouth  he  cleansed  when  there  is 
sprue ? 

It  should  be  washed  carefully  after  every  feeding 
or  nursing  with  a  solution  of  borax  or  bicarbonate  of 
soda  (baking  soda),  one  even  teaspoonful  to  three 
ounces  of  water,  and  four  times  a  day  the  boric-acid 
solution  mentioned  on  previous  page  should  be  used. 


Hoiu  should  the  infant's  shin  he  cared  for  to  pre- 
vent chafing? 

First,  not  too  much  nor  too  strong  soap  should  bo- 
used ;  secondly,  careful  rinsing  of  the  body ;  thirdly, 
not  too  vigorous  rubbing,  either  during  or  after  the 
bath;  fourthly,  the  use  of  dusting  powder  in  all  the 
folds  of  the  skin, — under  the  arms,  behind  the  ears, 
about  the  neck,  in  the  groin,  etc.  This  is  of  the- 
utmost  importance  in  very  fat  infants. 

If  the  sJcin  is  very  sensitive  and  chafing  easily 
produced,  what  should  he  done?  . 

!N"o  soap  should  be  used,  but  bran  or  salt  baths 
given  instead. 


20         THE    CAEE    AND    FEEDING   OF   CHILDREjS 

How  should  a  bran  hath  he  prepared? 

One  pint  of  wheat  bran  should  be  placed  in  a  bag 
of  coarse  muslin  or  cheese-cloth,  and  this  put  in  the 
bath  water.  It  should  then  be  squeezed  for  five  min- 
utes, until  the  water  resembles  a  thin  porridge. 

How  should  a  salt  hath  he  prepared? 
A  teacupful  of  common  salt  or  sea  salt  should  be 
used  to  each  two  gallons  of  water. 

Hovj  should  the  huttocks  he  cared  for? 

This  is  the  most  common  place  for  chafing,  as  the 
parts  are  so  frequently  wet  and  soiled;  hence  the 
utmost  pains  should  be  taken  that  all  napkins  be  re- 
moved as  soon  as  thej  are  wet  or  soiled,  and  the  parts 
kept  scrupulously  clean  and  well  powdered. 

If  the  parts  have  become  chafed^  what  should  be 
done? 

Only  bran  and  salt  baths  should  be  used,  and  in 
very  severe  cases  even  these  may  have  to  be  omitted 
for  a  day  or  t:wo.  The  parts  may  be  cleansed  with 
sweet  oil  and  a  little  absorbent  cotton,  and  the  skin 
kept  covered  with  a  dusting  powder  composed  of 
starch  two  parts,  boric  acid  one  part. 

What  is  pricMy  heat,  and  how  is  it  produced? 

It  consists  of  fine  red  j)imples,  and  is  usually 
caused  by  excessive  perspiration  and  the  irritation  of 
flannel  underclothing. 


CLOTHING  21 


-   /How  should  it  he  treated  ? 

Lighter  clotliing  should  be  used ;  muslin  or  linen 
should  be  put  next  to  the  skin;  the  entire  body 
should  be  sponged  frequently  with  equal  parts  of 
vinegar  and  water,  and  plenty  of  the  starch  and 
boric-acid  powder  mentioned  should  be  used. 


CLOTHIN^G 

What  are  the  most  essential  things  in  the  clothing 
of  infants  f 

That  the  chest  should  be  covered  with  soft  flannel, 
the  limbs  well  protected  but  not  confined,  and  the 
abdomen  supported  by  a  broad  flannel  band,  which 
should  be  snug  but  not  too  tight.  It  is  important 
that  the  clothing  should  fit  the  body.  If  it  is  too 
tight  it  interferes  with  the  free  movements  of  the 
chest  in  breathing,  and  by  pressing  upon  the  stomach 
sometimes  causes  the  infant  to  vomit  soon  after  swal- 
lowing its  food.  If  the  clothing  is  too  loose  it  is 
soon  thrown  into  deep  folds  or  bunches,  which  cause 
much  discomfort.  ISTo  pins  should  be  used,  but,  in- 
stead, all  bands  about  the  body  should  be  basted. 
The  petticoats  should  be  supported  by  shoulder 
straps. 


•22        THE   CARE   AKD   FEEDING   OF   CHILDEEN 

How  should  the  infant  he  held  during  dressing 
and  undressing? 

ISJ'otliing  is  more  awkward  than  to  attempt  to 
dress  a  young  babv  in  a  sitting  posture.  It  should 
lie  upon  the  nurse's  lap  until  quite  old  enough  to 
sit  alone,  the  clothing  being  drawn  over  the  child's 
feet,  not  slipped  over  the  head. 

Of  what  use  is  the  hand? 

It  protects  the  abdomen,  but  its  most  important 
use  is  to  support  the  abdominal  walls  in  very  young 
infants,  and  in  this  way  to  prevent  the  occurrence  of 
rupture. 

How  long  is  this  hand  required? 

The  snug  flannel  band,  not  usually  more  than 
three  or  four  months.  In  healthy  infants  with  plenty 
■of  fat  this  may  then  be  replaced  by  the  knitted  band, 
which  may  be  worn  up  to  eighteen  months.  The 
band  is  an  important  article  of  dress  in  the  case  of 
thin  infants  whose  abdominal  organs  are  not  suffi- 
ciently protected  by  fat.  With  such,'  or  with  those 
prone  to  diarrhoea,  it  is  often  advisable  to  continue 
the  band  until  the  third  or  fourth  year. 

What  changes  are  to  he  made  in  the  clothing  of 
infants  in  the  summer? 

Only  the  thinnest  gauze  flannel  undershirts 
should  be  worn,  and  changes  in  temperature  should 


CLOTHING  23 


,%.niet  by  changes  in  the  outer  garments.  The  great- 
est care  should  be  taken  that  children  are  not  kept 
too  hot  in  the  middle  of  the  day,  while  extra  wraps 
should  be  used  morning  and  evening,  especially  at 
the  seashore  or  in  the  mountains. 

Should  older  children  he  allowed  to  go  with  their 
legs,  hare  f 

If  strong  and  well  there  is  no  objection  to  this  in 
hot  weather.  In  cold  weather,  however,  it  i%  doubt- 
ful if  any  children  are  benefited  by  it,  particularly 
in  a  changeable  climate  like  that  of  New  York. 
Many  delicate  children  are  certainly  injured  by  such 
attempts  at  hardening. 

^Yhat  sort  of  underclothing  should  he  worn  dur- 
ing cold  weather? 

!N'ever  the  heaviest  weight,  even  in  winter.  Four 
grades  are  usually  sold,  the  next  to  the  heaviest  being 
thick  enough  for  any  child. 

Do  little  children  require  as  heavy  flannels  as 
older  people? 

'Not  as  a  rule.  They  usually  live  in  a  warm 
nursery;  their  circulation  is  active;  and  they  always 
perspire  easily  during  their  play.  When  they  go  out 
of  doors,  the  addition  of  coats  and  leggings  renders 
thick  flannels  unnecessary. 


24         THE    CAEE    AND    FEEDING   OF   CHILDREN 

Are  not  many  little  children  clothed  too  thinly 
for  the  ordinary  house? 

Very  few.  The  almost  invariable  mistake  made 
in  city  homes  is  that  of  excessive  clothing  and  too 
v^arm  rooms.  These  tv70  things  are  among  the  most 
frequent  reasons  for  their  taking  cold  so  easily. 


NAPKINS 

How  should  ndpJctns  he  taken  care  off 
They  should  be  immediately  removed  from  the 
nursery  v^hen  soiled  or  wet.     Soiled  napkins  should 
be  kept  in  a  receptacle  with  a  tight  cover,  and  washed 
as  soon  as  possible. 

Should  napkins  which  have  heen  only  wet  he 
used  a  second  time  ivithout  vjashing? 

It  is  no  doubt  better  to  use  only  fresh  napkins, 
but  there  is  no  serious  objection  to  using  them  twice 
unless  there  is  chafing  of  the  skin.  Clean  napkins, 
changed  as  soon  as  wet  or  soiled,  are  of  much  im- 
portance in  keeping  the  skin  healthy. 

What  are  the  important  things  to  he  ohserved  in 
washing  napkins? 

Soiled  napkins  should  not  be  allowed  to  dry,  but 
should  receive  a  rough  washing  at  once ;  they  should 


NUESEEY  25 


then,  be  kept  in  soak  in  plain  water  until  a  conve- 
nient time  for  washing, — at  least  once  every  day, — 
when  they  should  be  washed  in  hot  suds  and  boiled 
at  least  fifteen  minutes.  Afterward  they  should  be 
very  thoroughly  rinsed  or  they  may  irritate  the  skin, 
and  ironed  without  starch  or  blueing.  They  should 
never  be  used  when  damp. 


NURSERY 

What  are  the  essentials  in  a  good  nursery? 

The  furnishings  should  be  very  simple,  and  un- 
necessary hangings  and  upholstered  furniture  should 
be  excluded.  As  large  a  room  as  possible  should  be 
selected — one  that  is  well  ventilated,  and  always  one 
in  which  the  sun  shines  at  some  part  of  the  day,  as 
it  should  be  remembered  that  an  average  child  spends 
here  at  least  three  fourths  of  its  time  during  the  first 
year.  The  nursery  should  have  dark  shades  at  the 
windows,  but  no  extra  curtains ;  about  the  baby's 
crib  nothing  but  what  can  be  washed  should  be  al- 
lowed. The  air  should  be  kept  as  fresh  and  as  pure 
as  possible.  There  should  be  no  plumbing,  no  dry- 
ing of  napkins  or  clothes,  no  cooking  of  food,  and 
no  gas  burning  at  night.  A  small  wax  night-light 
answers  every  purpose. 


26         THE    CARE    AXD    FEEDIXG   OF   CHILDEEN 

How  should  a  nursery  he  heated? 

Best  by  an  open  fire;  next  to  this  bv  a  Franklin 
stove.  The  ordinary  hot-air  furnace  of  cities  has 
many  objections,  bnt  it  is  not  so  bad  as  steam  heat 
from  a  radiator  in  the  room.  A  gas  stove  is  even 
worse  than  this,  and  should  never  be  used,  except, 
perhaps,  for  a  few  minutes  during  the  morning 
bath. 

At  what  tenvperature  should  a  nursery  he  Icept 
during  the  day? 

Best,  64°  to  68°  F.,  measured  by  a  thermometer 
hanging  three  feet  from  the  floor.  The  tempera- 
ture should  not  be  allowed  to  go  above  70°  F. 

At  ivhat  temperature  during  the  night? 

During  the  first  two  or  three  months,  not  below 
65°  F.  After  three  months  the  temperature  may  go 
as  low  as  55°  F.  After  the  first  year  it  may  be  50° 
or  even  45°  F. 

At  what  age  may  the  window  he  left  open  at 
night ? 

Usually  after  the  third  month,  except  when  the 
outside  temperature  is  below  freezing  point. 

How  often  should  the  nursery  he  aired? 

At  least  twice  a  day — in  the  morning  after  the 
child's  bath,  and  again  in  the  evening  before  the 
child  is  put  to  bed  for  the  night.      This  should  be 


AIRING  27 

(lone  thoroughly,  and  the  child  should  be  removed 
meanwhile  to  another  apartment.  It  is  well  to  air 
the  nursery  whenever  the  child  is  out  of  the  room. 

What  symptoms  are  seen  in  a  child  who  is  kept 
in  too  hot  a  room? 

It  becomes  pale,  loses  appetite,  shows  symptoms 
of  indigestion,  occasionally  vomits,  stops  gaining  in 
weight,  perspires  very  much,  and  takes  cold  easily 
because  of  this  and  also  because  of  the  great  differ- 
ence between  the  indoor  and  outdoor  temperatures. 
Its  condition  may  be  such  as  to  lead  one  to  suspect 
very  serious  illness. 


AIEING 

How  early  may  airing  indoors  he  commenced  and 
how  long  may  it  he  continuedf 

Airing  in  the  room  may  be  begun  with  a  strong, 
healthy  child,  even  in  cold  weather,  when  he  is  one 
month  old,  at  first  for  only  fifteen  or  twenty  min- 
utes at  a  time.  This  period  may  be  gradually  length- 
ened by  ten  or  fifteen  minutes  each  day  until  it  is 
four  or  five  hours.  This  airing  may  be  continued  in 
almost  all  kinds  of  weather. 


28         THE   CAKE    AND    FEEDING   OF   CHILDEEN 

Is  there  not  great  danger  of  a  young  hahy's  talc- 
ing cold  ivhen  aired  in  this  nianjierf 

x^ot  if  the  period  is  at  first  short  and  the  bahj 
accustomed  to  it  gradually.  Instead  of  rendering  the 
child  liable  to  take  cold,  it  is  the  best  means  of  pre- 
venting colds. 

How  should  such  an  airing  he  given? 

The  child  should  be  dressed  with  bonnet  and  light 
coat  as  if  for  the  street  and  placed  in  its  crib  or  car- 
riage which  should  stand  a  few  feet  from  the  win- 
dow. All  the  windows  are  then  thrown  wide  open, 
but  the  doors  closed  to  prevent  draughts.  Screens 
are  unnecessary 

At  what  age  may  a  child  go  out  of  doors? 

In  summer,  when  one  week  old;  in  spring  and 
fall,  usually  at  about  one  month;  in  winter,  when 
about  three  months  old,  but  only  on  pleasant  days, 
being  kept  in  the  sun  and  out  of  the  wind. 

What  are  the  hest  hours  for  airing  out  of  doors? 

In  summer  and  early  autumn  a  child  may  be  out 
almost  any  time  between  seven  in  the  morning  and 
sunset;  in  winter  and  early  spring,  a  young  child 
only  between  10  or  11  a.  m.  and  3  p.  m.^  although 
this  depends  somewhat  upon  the  climate.     In  New 


AIRING  29 

York  and  along  the  Atlantic  coast  the  early  morn- 
ings are  apt  to  be  damp  and  the  afternoons  raw  and 
clondy. 

On  what  Tcind  of  days  should  a  hahy  not  go  out? 

In  sharp  winds,  when  the  ground  is  covered  with 
melting  snow,  and  when  it  is  extremely  cold.  A  child 
under  four  months  old  should  not  usually  go  out  if 
the  thermometer  i.s  below  freezing  point;  nor  one 
under  eight  months  old  if  it  is  below  20°  F. 

Exceptions  to  all  the  above  statements  are  to  be 
made  in  the  case  of  very  small  and  especially  deli- 
cate infants.  Though  they  should  have  fresh  air  in 
abundance,  they  should  be  much  more  carefully  pro- 
tected against  cold. 

What  are  the  most  important  things  to  he  attended 
to  when  the  child  is  out  in  its  carriage? 

To  see  that  the  wind  never  blows  in  its  face,  that 
its  feet  are  properly  covered  and  warm,  and  that  the 
sun  is  never  allowed  to  shine  directly  into  its  eyes 
when  the  child  is  either  asleep  or  awake. 

Of  ivhat  advantage  to  the  child  is  going  out? 

Fresh  air  is  required  to  renew  and  purify  the 
blood,  and  this  is  just  as  necessary  for  health  and 
grov^h  as  proper  food. 


30         THE   CAEE    AND    FEEDING   OF   CHILDEEN 

What  are  the  effects  'produced  in  infants  by  fresh 
air? 

The  appetite  is  improved,  the  digestion  is  better, 
the  cheeks  become  red,  and  all  signs  of  health  are 
seen. 

7s  there  any  advantage  in  having  a  child  take 
its  airing  during  the  first  five  or  six  months  in  the 
nurse's  arms? 

!N^one  whatever.  A  child  can  be  made  much  more 
comfortable  in  a  baby  carriage,  and  can  be  equally 
well  protected  against  exposure  by  blankets  and  the 
carriage  "ambrella. 

What  are  the  ohjections  to  an  infant's  sleeping 
out  of  doors? 

There  are  no  real  objections.  It  is  not  true  that 
infants  take  cold  more  easily  when  asleep  than  awake, 
while  it  is  almost  invariably  the  case  that  those  who 
sleep  out  of  doors  are  stronger  children  and  less  prone 
to  take  cold  than  others. 

What  can  he  done  for  older  children  who  taJce 
cold  upon  the  slightest  provocation? 

They  should  be  kept  in  cool  rooms,  especially 
when  asleep.  They  should  not  wear  such  heavy 
clothing  that  they  are  in  a  perspiration  much  of 
the  time.     Every  morning  the  body,  particularly  the 


WEIGHT,    GROWTH,   AND    DEVELOPMENT  3l 

neck,  chest,  shoulders  and  back,  should  be  sponged 
with  cold  water  (50°  to  60°  F.). 

How  should  this  cold  sponge  hath  he  given? 

The  child  should  stand  in  a  tub  containing  a 
little  warm  water,  and  a  large  bath  sponge  filled  with 
•cold  water  should  be  squeezed  two  or  three  times 
over  chest  and  shoulders.  For  best  effects  this  sponge 
bath  should  be  very  cold  and  very  short.  It  should 
be  followed  by  a  vigorous  rubbing  with  a  towel  until 
the  skin  is  quite  red.  Thife  may  be  begun  at  three 
years,  and  often  at  two  years.  For  infants  a  little 
higher  temperature  (65°  to  70°  F.)  may  be  used. 

WEIGHT^    GROWTH^    AND   DEVELOPMEIN'T 

Of  what  importance  is  the  weight  of  the  child? 

!Rothing  else  tells  so  accurately  how  well  it  is 
thriving. 

During  the  first  year  a  record  of  the  weight  is 
almost  indispensable;  throughout  childhood  it  is  of 
much  interest  and  is  the  best  guide  to  the  physical 
condition.  It  will  well  repay  any  mother  or  nurse 
to  keep  such  a  record. 

IIoiD  frequently  should  a  child  he  iveighedf 
Every  week  during  the  first  six  months,  and  at 
least  once  in  two  weeks  during  the  last  six  months 


32         THE    CARE    AND    FEEDING   OF   CHILDREN 


of  the  first  year.     During  the  second  year  a  child 
should  be  weighed  at  least  once  a  month. 

How  rapidly  should  an  infant  gain  in  weight 
during  the  first  year? 

There  is  usually  a  loss  during  the  first  week  of 
from  four  to  eight  ounces ;  after  this  a  healthy  child 
should  gain  from  four  to  eight  ounces  a  week  up  to 
about  the  sixth  month.  From  six  to  twelve  months 
the  gain  is  less,  usually  from  two  to  four  ounces  a 
week. 

Is  it  to  he  expected  that  bottle-fed  infants  will 
gain  as  rapidly  as  those  ivho  are  nursed  f 

They  seldom  do  so  during  the  first  month ;  after 
that  time  under  favourable  circumstances  the  gain 
is  usually  quite  as  regular,  and  during  the  latter 
half  of  the  first  year  it  is  likely  to  be  more  con- 
tinuous than  in  a  nursing  infant,  because  the  latter 
usually  loses  weight  at  the  time  of  weaning. 

Why  do  they  not  gain  so  rapidly  at  first  f 
It  takes  a  few  weeks  for  the  stomach  to  become 
accustomed  to  cow's  milk,  and  until  this  is  accom- 
plished it  is  necessary  to  make  the  milk  very  weak 
01  the  child's  digestion  will  be  upset. 


WEIGHT,   GEOWTH,   AND   DEVELOPMENT  33 

-  For  a  child  of  average  weight  at  hirth  {seven 
to  seven  and  a  half  pounds)  what  should  he  the 
weight  at  the  different  'periods  during  the  first 
year? 

At  three  months  it  should  be  twelve  to  thirteen 
pounds;  at  six  months,  fifteen  to  sixteen  pounds;  at 
nine  months,  seventeen  to  eighteen  pounds;  at  one 
year,  twenty  to  twenty-two  pounds.  At  ^yq  months 
an  average  healthy  child  has  doubled  its  weight,  and 
at  twelve  months  it  has  nearly  trebled  its  weight. 

Do  all  healthy  infants  gain  steadily  in  weight 
during  the  first  yearf 

As  a  rule  thej  do;  jet  it  is  seldom  the  case  that 
one  gains  every  week  for  the  entire  year.  With  most 
infants  there  are  from  time  to  time  periods  of  a  few 
weeks  in  which  no  gain  is  made.  These  are  more 
often  seen  from  the  seventh  to  the  tenth  month  and 
frequently  occur  when  the  child  is  cutting  teeth, 
sometimes  during  very  hot  weather. 

7s  it  true  that  every  infant  who  gains  rapidly  in 
weight  is  thriving  normally  f 

I^ot  invariably.  Some  who  are  fed  upon  pre- 
pared infant  foods  increase  rapidly  in  weight  but 
not  in  strength,  nor  in  their  development  in  other 
respects. 


34    THE  CAEE  AND  FEEDING  OF  CHILDEEN 

Is  the  iveight  of  as  much  value  in  the  second  year 
as  a  guide  to  the  child's  condition'^ 

After  the  first  year,  the  gain  in  weight  is  seldom 
continuous ;  there  are  many  interruptions,  some  de- 
pend on  season,  and  others  often  occur  without  ap- 
parent cause. 

At  what  age  should  the  fontanel  close? 

The  average  is  about  eighteen  months.  It  seldom, 
closes  earlier  than  fourteen  months,  and  it  should 
not  be  open  at  two  years. 

At  ivhat  age  should  a  child  hold  up  its  head? 

As  a  rule  during  the  fourth  month,  and  often 
during  the  third  month,  the  head  can  be  held  erect 
when  the  body  is  supported. 

When  does  an  infant  first  laugh  aloud? 
Usually  from  the  third  to  the  fifth  month. 

When  does  it  hegin  to  reach  for  toys  and  handle 
them? 

Usually  from  the  fifth  to  the  seventh  month. 

At  what  age  should  a  child  he  ahle  to  sit  and  to 
stand  alone? 

At  seven  or  eight  months  a  healthy  child  is  usu- 
ally able  to  sit  erect  and  support  the  body.  During 
the  ninth  and  tenth  months  are  usually  seen  the  first 
attempts  to  bear  the  weight  upon  the  feet,  and  at 


WEIGHT,   GROWTH,  AND   DEVELOPIMENT  39 

eleven  or  tAvelve  months  most  children  can  stand  with, 
assistance. 

^yllen  should  a  child  wallv  alone? 

The  first  attempts  are  generally  seen  in  the 
twelfth  or  thirteenth  month.  At  fifteen  or  sixteen 
months  the  average  child  is  able  to  run  alone. 

^yhat  conditions  postpone  these  events? 

Prematurity,  a  very  delicate  constitution,  any 
severe  or  prolonged  illness,  and  especially  chronic- 
disturbances  of  digestion  making  feeding  difficult. 
A  common  cause  of  late  sitting,  standing,  or  walk- 
ing is  rickets. 

Should  a  child  he  urged  to  walk? 

!N^ever;  he  is  usually  quite  w^illing  to  do  so  as- 
soon   as   his  muscles   and  bones   are  strong  enough. 
'None  of  the   contrivances  for  teaching  children  tO' 
walk  are  to  be  advised. 

When  do  children  hegin  to  talk? 

Generally  at  one  year  a  child  can  say  ^^papa" 
and  ^^mamma"  or  other  single  words.  At  the  end 
of  the  second  year  the  average  child  is  able  to  put 
words  together  in  short  sentences. 

If  at  two  years  the  child  makes  no  attempt  to 
speak,  ivhat  should  he  suspected? 

Either  that  the  child  is  a  deaf-mute  or  that  it  is- 


.36         THE    CAEE    AND    FEEDING    OF    CHILDEEN 


mentally  deficient,  althongli  this  is  occasionally  seen 
in  children  who  are  in  other  respects  quite  normal. 


Table  showing  the  Average  Weight,   Height,   and  Circuni' 
ference  of  Head  and  Chest  of  Boys^ 

At  birth Weight 73^  pounds 

Height 203^  inches. 

Chest 133^      " 

Head 14 

One  year Weight 21  pounds. 

Height 29    inches. 

Chest 18 

Head 18 

Two  years Weight 27  pounds. 

Height 32  inches. 

Chest 19 

Head 19 

Three  years Weight 32    pounds. 

Height 35    inches 

Chest 20 

Head 19M    '' 

Four  years Weight 36    pounds. 

Height 38    inches. 

Chest 20M    " 

Head 19%    " 

Five  years Weight 41    pounds. 

Height 413^  inches. 

Chest 213^       " 

Head 203^       " 

^  Weights  for  the  first  four  years  are  without  clothes. 

The  weight  of  girls  is  on  the  average  about  one  pound  lesa 
'than  boys.     They  are  about  the  same  in  height. 

Charts  showing  weight  curve  for  the  first  year,  and  from  one 
■year  to  fourteen  years  are  given  at  the  end  of  this  book 


DENTITION  sr 


Six  years Weight 45    pounds. 

Height 44    inches. 

Chest 23 

Seven  years Weight 493^  pounds. 

Height 46    inches. 

Chest.. 233^       " 

Eight  years Weight 543^  pounds. 

Height 48    inches. 

Chest 243^       " 

Nine  years Weight 60    pounds. 

Height 50    inches. 

Chest 25 

Ten  years W^eight 663^  pounds. 

Height 52    inches. 

Chest 26 

The  above  weights  are  with  ordinary  house  clothes. 


DEI^TITIOK 

How  tnany  teeth  are  there  in  the  first  set? 
Twenty. 

What  is  the  time  of  their  appearance  f 
The  two  central  lower  teetk  are  usually  the  first 
to  appear,  and  come  from'  the  fifth  to  the  ninth 
month;  next  are  the  four  upper  central  teeth,  which 
come  from  the  eighth  to  the  twelfth  month.  The 
other  two  lower  central  teeth  and.  the  four  front 
double  teeth  come  from  the  twelfth  to  the  eighteenth 
month.  Then  follow  the  four  canine  teeth,  the  two 
upper  ones  being  known  as  the  ''eye  teeth,"  and  the 


58        THE    CARE    AND    FEEDING   OF   CHILDREN 

two  lower  as  the  "stomacli  teeth" ;  they  generally 
€01116  between  the  eighteenth  and  the  twenty-fourth 
month.  The  four  back  double  teeth,  which  complete 
the  first  set,  come  between  the  twenty-fourth  and 
"thirtieth  month. 

At  one  year  a  child  usually  has  six  teeth. 

At  one  and  a  half  years,  twelve  teeth. 

At  two  years,  sixteen  teeth. 

At  two  and  a  half  years,  twenty  teeth. 

What  are  the  causes  of  variation? 

The  time  of  appearance  of  the  teeth  varies  in 
•different  families;  in  some  they  come  very  earlj', 
in  others  much  later.  The  teeth  may  come  late  as 
^  result  of  prolonged  illness  and  also  from  rickets. 

What  symptoms  are  commonly  seen  ivith  teeth- 
ing ? 

In  healthy  children  there  is  very  often  fretful- 
ness  and  poor  sleep  for  two  or  three  nights;  there 
may  be  loss  of  appetite,  so  that  only  one  half  the 
usual  amount  of  food  is  taken;  there  is  salivation 
or  drooling,  and  often  slight  fever;  there  may  be 
some  symptoms  of  indigestion,  such  as  vomiting  or 
the  appearance  of  undigested  food  in  the  stools.  In 
•delicate  children  all  these  symptoms  may  be  much 
more  severe. 


DENTITION  39 


-     How  long  do  these  symptoms  last? 
'  •iTsiially  only  three  or  four  days;  but  there  may 
be  no  gain  in  weight  for  two  or  three  weeks. 

What  is  the  cause  of  most  of  the  other  symptoms 
attributed  to  teething? 

Nearly  all  of  them  come  from  indigestion  due  to 
bad  feeding. 


PART   II 


II 

INFANT  FEEDING 

What  is  the  test  infant  food? 
Mother's  milk. 

Of  what  is  mother  s  milk  composed  f 
Thirteen  parts  solids  and  eighty-seven  water. 

What  are  the  solids? 

Fat,  sugar,  protein,  and  salts. 

What  is  the  fat? 
The  cream. 

What  is  the  sugar? 

It  is  lactose,  or  milk  sugar. 

What  is  the  protein? 
The  curd  of  the  milk. 

Are  all  these  elements  necessary? 
Yes;  we  cannot  expect  to  rear  a  healthy  infant 
imless  they  are  all  in  his  food. 

43 


44        THE    CAEE    AND    FEEDING    OF    CHILDREN 

Of  what  use  is  the  fat? 

It  is  needed  for  the  gTowth  of  bones,  nerves,  the 
fat  of  the  body,  and  the  production  of  heat. 

Of  what  use  is  the  sugar? 

It  is  needed  for  the  production  of  heat,  and  to 
make  fat  in  the  body. 

Of  what  use  is  the  protein? 

It  is  needed  for  the  growth  of  the  body  cells, 
such  as  those  of  the  blood,  the  organs,  and  the  mus- 
cles. 

Of  what  u^e  are  the  salts? 
Particularly  for  the  growth  of  bone. 

Of  what  use  is  the  water? 

By  means  of  the  water  the  food  is  kept  in  a  state 
of  minute  subdivision  or  in  solution,  so  that  the  deli- 
cate organs  of  the  infant  can  digest  it.  It  is  also 
necessary  to  enable  the  body  to  get  rid  of  its  waste. 


NTJESING 

Why  should  ynothers  nurse  their  children? 

First,  because  there  is  no  perfect  substitute  for 
good  breast-feeding.  Secondly,  statistics  show  that 
the  mortality  of  bottle-fed  infants  during  the  first 


NURSING  45 


year  is  fully  three  times  as  gi-eat  as  that  of  those 
'who  are  breast-fed. 

At  what  period  is  nursing  of  greatest  importance? 

During  the  first  three  or  four  months,  to  give  the 
child  a  proper  start.  At  this  time  of  life  the  mor- 
tality is  highest  and  artificial  feeding  is  most  difiicult. 

When  should  maternal  nursing  not  he  attempted? 

If  the  mother  has  or  has  had  tuberculosis  or  any 
other  serious  chronic  disease,  or  is  herself  in  very 
delicate  health,  she  should  not  try.  She  is  likely  soon 
to  fail  in  nourishing  her  child,  and  the  attempt  may 
do  herself  much  harm  as  well  as  injure  the  child. 

How  often  should  infants  he  nursed  during  the 
first  two  days  of  life? 

Usually  only  four  or  five  times  daily,  since  there 
is  very  little  milk  secreted  at  this  time. 

When  does  the  milk  come  in  ahundance? 
Usually  on  the  third  day,  sometimes  not  until 
the  fourth  or  fifth  or  even  the  ninth  or  tenth  day. 

Should  the  infant  he  fed  anything  additional  dur- 
ing the  first  two  days? 

Usually  not ;  if  much  food  were  necessary,  we 
may  be  sure  ^Nature  would  have  provided  it.  Water, 
however,  should  be  given  regularly. 


46        THE    CAEE    AXD    FEEDING    OP    CHILDEEN" 

How  frequently  should  an  infant  he  nursed  dur- 
ing the  first  weeJc? 

After  the  third  day,  eyery  three  hours  during  the 
day  and  twice  during  the  night.  The  frequency 
during  the  entire  first  year  is  giyen  in  the  following 
table : 


Period. 

Nursings  in 
24  hours. 

Inter\'al  by  day. 

Night  nursings 

(6  P.il.  to  6  A.M.) 

1st  and  2nd  daj- .... 

3  days  to  2  weeks. . . 
2  weeks  to  4  months 

4  to  7  months 

7  to  12  months 

4 

7 
7 
6 
5 

6  hours. 
3      " 
3      " 

3  '' 

4  " 

1 
2 
2 
1 

0 

How  long  sliould  the  child  he  Icept  at  the  hreast 
for  one  nursing? 

Xot  oyer  twenty  minutes. 

Shoidd  the  child  take  hoth  hreasts  at  one  nursing? 
If  the  milk  is  yery  abundant  one  breast  may  be 
sufficient,  otherwise  both  breasts  may  be  taken. 

What  are  the  important  things  to  he  attended  to 
in   nursing  ? 

First,  regTilarity;  it  is  just  as  important  as  in 
the  case  of  bottle-feeding.  Secondly,  the  nipples 
should  be  kept  clean  by  being  washed  after  eyery 
nursing. 


NUESIXG  47 


-  What  should  he  the  diet  of  a  nursing  mother? 

'  Siie  should  have  a  simple  but  generous  diet  with 
plenty  of  fluids;  three  regular  meals  may  be  given, 
and  gruel,  milk,  or  cocoa  at  bed-time  and  sometimes 
between  meals.  She  may  take  eggs,  cereals,  most 
soups,  and  nearly  all  vegetables,  avoiding  sour  fruits, 
salads,  pastry,  and  most  desserts.  Meat  should  not 
be  taken  more  than  twice  daily,  and  in  many  cases 
but  once.  She  should  take  but  little  tea  or  coffee, 
and  ordinarily  no  wine  or  beer. 

» 
Are  fruits  lihely  to  disturb  a  nursing  infant? 
Sour  fruits  in  some  cases  may  do  so,  but  sweet 
fruits  and  most  cooked  fruits  are  useful. 

What  else  is  important  in  the  life  of  the  nursing 
mother? 

She  should  lead  a  simple  natural  life;  should 
have  regular  out-of-door  exercise,  preferably  walking 
or  driving,  as  soon  after  her  confinement  as  her  con- 
dition will  permit.  She  should  have  regTilar  move- 
ments from  the  bowels  daily.  She  should  be  as  free 
as  possible  from  unnecessary  cares  and  worry;  her 
rest  at  night  should  be  disturbed  as  little  as  possible ; 
she  should  go  to  bed  early  and  lie  down  for  at  least 
one  hour  in  the  middle  of  the  day. 


48        THE    CAEE    AXD    FEEDING    OF    CHILDEEN 

Does  the  nervous  condition  of  the  mother  affect 
the  milk? 

Very  mucli  more  than  her  diet ;  worry,  anxiety, 
fatigue,  loss  of  sleep,  household  cares,  social  dissipa- 
tion, etc.,  have  more  than  anything  else  to  do  with 
the  failure  of  the  modern  mother  as  a  nurse.  Uncon- 
trolled emotions,  grief,  excitement,  fright,  passion, 
may  cause  milk  to  disagree  with  the  child ;  at  times 
they  may  excite  acute  illness,  and  at  other  times  they 
may  cause  a  sudden  and  complete  disappearance  of 
the  milk. 

Does  menstruation  affect  the  millcf 

In  nearly  all  cases  the  quantity  of  milk  is  less- 
ened during  the  period  so  that  the  infant  is  not  satis- 
fied and  may  not  gain  in  weight.  In  many  cases  the 
quality  of  the  milk  is  also  affected  to  such  a  degree  as 
to  cause  slight  disturbances  of  digestion,  like  restless- 
ness, colic,  or  some  derangement  of  the  bowels.  In 
a  few,  attacks  of  acute  indigestion  are  excited. 

7s  the  return  of  menstruation  a  reason  for  stop- 
ping nursing? 

^ot  usually ;  as  a  rule  both  functions  do  not  go 
on  together.  But  if  the  child  is  gaining  regularly  in 
weight  between  the  periods,  nursing  may  be  con- 
tinued indefinitely,  although  it  may  be  well  to  feed 


NUESING  49 


the  infant  wholly  or  in  part  during  the  first  day  or 
two 'that  the  mother  is  iinwell. 


What  symptoms  indicate  that  a  nursing  infant  is 
well  flourished? 

The  child  has  good  color,  sleeps  two  or  three 
hours  after  nursing,  or,  if  awake,  is  quiet,  good-na- 
tured, and  apparently  comfortable.  It  has  normal 
movements  of  the  bowels  and  gains  weight  steadily* 

What  symptoms  indicate  a  scanty  milk  supply 
and  that  an  infant  who  is  nursing  is  not  properly 
nourished? 

It  does  not  gain  and  may  even  lose  in  weight.  It 
no  longer  exhibits  its  usual  energy  and  playfulness,, 
but  is  either  listless  and  indifferent  or  cross,  fretful 
and  irritable,  and  is  apt  to  sleep  poorly.  It  grows 
pale  and  anaemic  and  its  tissues  become  soft  and 
flabby.  When  the  milk  is  scanty  it  will  often  nurse  a 
long  time  at  the  breasts,  sometimes  three  quarters 
of  an  hour,  before  stopping.  At  other  times  it  may 
take  the  breast  for  a  moment  only,  and  then  turn 
away  in  apparent  disgust.  The  only  sure  way  of 
telling  how  much  milk  a  child  is  getting  is  to  weigh  it 
before  and  after  nursing,  four  or  five  times  a  day; 
the  child  need  not  be  undressed  for  this  purpose. 


50        THE    CAEE    AND    FEEDING    OF    CHILDEEN 

What  should  he  done  in  such  cases? 

This  depends  upon  the  severity  of  the  sjTiiptoms 
and  how  long  they  have  lasted.  If  the  child  has  made 
no  gain  for  several  weeks,  or  is  losing  weight,  im- 
mediate weaning  will  probably  be  necessary;  in 
any  case,  other  food  in  addition  to  the  breast  milk 
.should  be  given  at  once.  One  may  alternate  the  nurs- 
ing and  the  bottle-feeding  and  increase  the  number 
•of  bottle-feedings  as  may  be  indicated  by  the  results, 
•or  still  better  nurse  as  before  and  give  a  smaller  bot- 
tle-feeding after  the  child  has  taken  the  breast.  A 
scanty  secretion  is  likely  to  be  still  further  reduced 
loj  lessening  the  number  of  nursings,  while  more 
frequent  nursings  tend  to  increase  the  flow. 

Is  there  any  ohjection  to  a  hahy  heing  partly 
nursed  and  partly  fed? 

'None  whatever;  it  is  often  better  from  the  out- 
set to  feed  the  baby  during  the  night,  in  order  not 
i;o  disturb  the  mother's  rest.  If  the  mother  has  only 
milk  enough  for  two  or  three  nursings  a  day,  this 
should  be  continued  so  long  as  her  milk  agrees  with 
the  baby.  Even  a  small  amount  of  good  breast  milk 
greatly  improves  a  child's  nutrition. 

What  symptoms  indicate  that  the  mother  s  milk 
disagrees  with  the  child  f 

This  should  be  carefully  distinguished  from  tne 


NUESING  51 


ingre  common  condition  of  hunger  due  to  scanty 
milk.  If  the  milk  disagrees,  the  child  suffers  from 
almost  constant  discomfort ;  sleeps  little  and  then  rest- 
lessly, cries  a  great  deal,  helches  gas  from  the  stom- 
ach, and  passes  much  by  the  bowels,  or  if  not  passed, 
the  gas  accumulates  and  causes  abdominal  distention 
and  colicky  pain.  There  may  be  vomiting,  but  more 
often  the  trouble  is  intestinal.  Sometimes  the  bowels 
are  constipated,  but  usually  the  movements  are  fre- 
quent, loose,  green,  contain  mucus  and  are  passed 
with  much  gas. 

What  should  he  done  under  these  circumstances? 

If  the  symptoms  have  persisted  for  two  or  three 
weeks  and  the  child  is  not  gaining  in  weight,  there 
is  little  chance  of  improvement,  and  the  child  should 
be  taken  from  the  breast  at  once.  If  there  is  some 
gain  in  weight,  one  may  try  for  a  little  longer,  en- 
deavoring to  improve  the  mother's  milk  by  rest, 
fresh  air,  careful  diet,  etc.  However,  one  should 
realize  that  the  trouble  is  nearly  always  with  the 
milk,  not  with  the  child. 

What  changes  should  he  made  if  a  nursing  infant 
hahituaUy  vomits? 

If  this  occurs  soon  after  nursing,  the  infant  has 
usually  taken  too  much ;  the  time  of  nursing  should 


52        THE    CARE    AND    FEEDING    OF    CHILDREN 

be  shortened  or  only  one  breast  given,  l^ursing 
should  be  interrupted,  and  the  child  placed  upright 
io  enable  him  to  get  rid  of  the  gas  in  the  stomach. 
If  the  vomiting  occurs  some  time  after  nursing  and 
is  repeated,  it  is  a  sign  of  indigestion ;  often  the  milk 
is  too  rich  in  fat.  The  intervals  between  nursings 
should  be  lengthened  to  three  and  a  half  or  even  four 
hours ;  the  breast  milk  may  be  diluted  by  giving  one 
or  two  tablespoonfuls  of  plain  boiled  water,  or  barley- 
water,  five  or  ten  minutes  before  nursing ;  the  mother 
should  eat  less  hearty  food,  especially  less  meat.  If 
the  child  is  thriving  and  gaining  regularly  in  weight 
the  vomiting  will  in  most  cases  gradually  improve 
with  the  changes  in  regime  mentioned;  but  if  the 
child  is  losing  weight  weaning  is  usually  advisable. 

What  should  he  done  if  the  infant  has  frequent 
habitual  colic? 

The  mother  should  take  more  out-of-door  exer- 
cise, eat  less  meat  and  seek  to  control  her  emotions ; 
all  causes  of  worry  should  be  removed.  If  the  con- 
stipation which  accompanies  this  condition  is  re- 
lieved, the  colic  will  usually  disappear  also.  It  is 
often  useful  to  increase  the  interval  between  feedings. 

Can  constipation  in  a  nursing  infant  he  con- 
trolled through   the  mothers  milk? 

Only  to  a  limited  extent.     It  is  important  that 


WEANING  53 


the  mother's  bowels  be  regular  ar^d  her  digestion  good. 
An  increase  in  the  meat  and  milk  of  her  diet  is  some- 
times beneficial. 

Should  a  mother  with  a  cold  continue  to  nurse 
her  hahyf 

The  danger  of  infecting  the  child  while  nursing 
is  considerable.  Many  common  colds  are  very  con- 
tagious and  these  often  have  serious  consequences  in 
young  infants.  It  is  not  necessary  to  stop  nursing, 
but  while  nursing  the  mother  should  cover  her 
mouth  and  nose  w  th  a  handkerchief,  and  on  no 
account  should  she  kiss  the  infant  or  cough  or  sneeze 
while  nursing. 

WEANII^G 

At  what  age  should  the  child  he  weaned  from 
the  breast? 

Usually  weaning  should  be  begun  at  nine  or  ten 
months  by  substituting  one  feeding  a  day  for  one 
nursing,  later  two  feedings,  and  thus  gradually  the 
child  is  to  be  taken  from  the  breast  altogether. 

What  is  the  principal  reason  for  weaning  earlier? 

The  most  important  one  is  that  the  child  is  not 
thriving — not  gaining  in  weight  nor  progressing  nor- 
mally in  development.  Serious  illness  of  the  mother, 
or  pregnancy,  may  make  weaning  necessary. 


54        THE    CAEE    AND    FEEDING    OF    CHILDEEN 

At  what  age  should  the  weaning  he  completed? 

Generally  at  one  year.  In  summer  it  may  some- 
times be  advisable  to  nnrse  an  infant  a  little  longer 
rather  than  wean  in  warm  weatber;  but  even  tben 
tbe  dangers  of  weaning  are  much  less  than  those  of 
continuing  to  nurse,  as  is  so  often  done,  after  the 
milk  has  become  very  scanty  and  poor  in  quality. 

When  shoidd  a  child  ivho  is  iveaned  from  the 
hreast  he  taught  to  drinh  from  the  cup,  and  when 
to  tahe  the  hottle? 

If  weaning  is  done  as  early  as  the  eighth  or  ninth 
month  it  is  better  to  give  the  bottle ;  if  from  the  tenth 
to  the  twelfth  month  the  infant  should  be  taught  to 
drink  or  be  fed  with  a  spoon. 

How  may  some  difficulties  in  weaning  he  over- 
come? 

Bv  feeding  every  nursins^  infant  once  a  dav  or 
by  giving  it  water  regularly  from  a  feeding-bottle. 
It  then  becomes  accustomed  to  the  bottle.  This  is  a 
matter  of  gTeat  convenience  during  the  whole  period 
of  nursing  when  the  mother  or  nurse  may  from  neces- 
sity be  away  from  the  child  for  a  few  hours;  when 
more  feedings  are  required  at  the  time  of  weaning 
the  child  does  not  object. 


WEANING  55 


.  \',W}ien  should  a  child  he  weaned  from  the  bottle  f 
With  cHildren  who  are  not  ill,  weaning  from  the 
bottle  should  invariably  be  begun  at  the  end  of  the 
first  year,  and  after  a  child  is  thirteen  or  fourteen 
months  old  the  bottle  should  not  be  given  except  at 
the  night  feeding. 

7s  there  any  objection  to  the  child's  talcing  the 
bottle  until  it  is  two  or  three  years  old? 

There  are  no  advantages  and  some  serious  objec- 
tions. Older  children  often  become  so  attached  to 
the  bottle  that  only  with  the  greatest  difficulty  can 
they  be  made  to  give  it  up.  Frequently  they  will 
refuse  all  solid  food,  and  will  take  nothing  except 
from  the  bottle  so  long  as  it  is  given,  and  when  finally^ 
at  three  or  four  years,  it  is  taken  away,  they  will 
not  touch  milk  during  the  rest  of  their  child- 
hood. The  difficulty  is  here  that  children  form  the 
^'bottle  habit.''  This  habit  is  troublesome,  unneces- 
sary, and  should  by  all  means  be  prevented.  An 
exclusive  diet  of  milk  for  children  of  two  or  three 
years  often  results  in  ansemia  and  malnutrition. 

How  should  one  train  a  child  to  do  without  the 
bottle? 

This  is  usually  easy  if  it  is  beg-un  early.  The 
milk  should  be  poured  into  a  tiny  glass  or  cup  and 


56        THE    CARE    AND    FEEDING    OF    CHILDREN 

little  by  little  the  child,  is  taught  to  drink  or  to  take 
food  from  a  spoon;  at  first  only  a  small  portion  of 
the  food  is  taken  in  this  way,  the  balance  being  given 
from  the  bottle;  but  in  a  few  weeks  the  average  in- 
fant learns  to  drink  from  a  cup  without  difiiculty. 

If  the  child  has  been  allowed  to  have  the  bottle 
until  he  is  two  or  more  years  old,  the  only  effective 
means  of  weaning  is  through  hunger.  The  bottle 
should  be  taken  away  entirely,  and  nothing  allowed 
except  milk  from  a  cup  until  the  child  takes  this 
willingly.  Sometimes  a  child  will  go  an  entire  day 
without  food,  occasionally  as  long  as  two  days,  but 
one  should  not  be  alarmed  and  yield.  This  is  a  mat- 
ter of  the  child's  will,  not  his  digestion,  and  once 
he  has  been  conquered  there  is  seldom  any  further 
trouble.  As  soon  as  a  child  has  learned  to  drink  his 
milk  from  a  cup,  cereals  and  other  solid  foods  may 
gradually  be  added  to  the  diet.  The  educational 
value  of  such  training  is  not  the  least  important  con- 
sideration. 

Can  a  hahy  just  weaned  tahe  cow's  milk  of  the 
same  proportions  as  one  of  the  same  age  who  has  had 
cow's  milk  from  hirth? 

Very  rarely ;  to  give  a  baby  who  has  had  nothing 
but  the  breast  from  birth,  plain  cow's  milk,  or  even 
that  milk  which  a  bottle-fed  baby  of  the  same  age 


WEANING  57 


might  take,  is  almost  certain  to  cause  indigestion. 
Tlie  change  in  the  food  is  quite  a  marked  one,  and 
should  be  made  gradually  by  beginning  with  a  weak 
milk  and  increasing  its  strength  as  the  baby  becomes 
accustomed  to  take  cow's  milk. 

What  would  he  the  proper  proportions  for  an  in- 
fant weaned  at  four  or  five  months? 

About  the  same  as  for  a  healthy  bottle-fed  infant 
of  two  months;  the  quantity  of  course  should  be 
larger.  The  food  can  in  most  cases  be  gradually  in- 
creased so  that  in  two  or  three  weeks  the  usual 
strength  for  the  age  can  be  taken. 

What  would  he  the  proper  proportions  for  an  in- 
fant weaned  at  nine  or  ten  nfionthsf 

About  the  same  as  for  a  bottle-fed  infant  at  four 
or  five  months,  to  be  increased  as  indicated  above. 

Will  not  a  child  lose  in  weight  when  placed  upon 
so  low  a  diet? 

Very  often  it  will  do  so  for  the  first  week  or  two, 
but  after  that  will  gain  quite  regularly;  the  acute 
indigestion,  however,  which  generally  accompanies 
the  use  of  stronger  milk  will,  in  most  cases,  cause  a 
greater  loss. 


58        THE    CAEE    AND    FEEDING    OF    CHILDEEN 
'-'  AETIFICIAI.    PEEDIWG- 

y^  What  foods  contaiii  all  the  elements  present  in 
mother  s  milk? 

The  milk  of  other  animals, — cow's  milk  being  the 
only  one  which  is  available  for  general  use. 

7s  it  not  possible  for  infants  to  thrive  upon  other 
foods  than  those  containing  fresh  milk? 

They  may  do  so  for  a  time,  but  never  perma- 
nently. The  long-continned  nse  of  other  foods  as 
the  sole  diet  is  attended  with  gTeat  risk.     • 

What  are  the  dangers  of  such  foods  ? 

Preqnently  scnrvy  is  produced,  and  in  other  cases 
simply  a  condition  of  general  malnutrition, — ^the 
child  does  not  thrive,  is  pale,  and  its  muscles  are  soft 
and  flabby. 

THE  SELECTION  AND  CAEE  OP  MILK  USED  FOE  INFANT 

FEEDING 

What  are  the  essential  points  in  milk  selected  for 
the  feeding  of  infantsf 

That  it  comes  from  healthy  cows,  is  handled  only 
by  healthy  persons,  and  that  it  is  clean  and  fresh. 

Is  it  not  important  to  select  a  rich  milk? 
By  no  means ;  in  fact  the  verj^  rich  milk  of  highly 
bred  Jerseys  and  Alderneys  has  not  been  found  nearly 


THE    SELECTION    AND    CAEE    OF    MILK  59 


SO  satisfactory  in  infant  feeding  as  that  from  some 
other  herds,  such,  for  example,  as  the  common  "grade 


cows." 


Which  is  the  tetter,  milk  from  one  coiv  or  the 
mixed  milk  of  several  cowsf 

The  mixed,  or  "herd  milk,"  is  usually  to  be  pre- 
ferred, since  it  varies  little  from  day  to  day;  while 
that  from  a  single  cow  may  vary  considerably. 

How  fresh  is  it  important  that  cow's  milk  should 
he  for  the  best  results  in  infant  feeding? 

This  depends  very  much  upon  the  season,  and 
how  carefully  milk  is  handled.  As  ordinarily  han- 
dled at  the  dairy  and  in  the  home,  milk  should  not 
be  used  for  infants  in  winter  after  it  is  forty-eight 
hours  old ;  in  summer  not  after  it  is  twenty-four  hours 
old,  and  it  may  be  unsafe  in  a  much  shorter  time. 
When  handled  with  especial  care  milk  may  be  safe 
for  a  longer  time. 

What  are  the  two  essentials  in  handling  milh? 

1.  That  it  be  kept  clean  and  free  from  contami- 
nation. This  necessitates  that  cows,  stables,  and 
milkers  be  clean,  and  that  transportation  be  in  sealed 
bottles ;  also  that  those  who  handle  the  milk  are  them- 
selves healthy  and  do  not  have  or  come  in  contact  with 
any  contagious  disease.  All  milk-pails,  bottles,  cans, 
and  other  utensils  with  which  the  milk  comes  in  con- 


60        THE    CAEE    AND    FEEDING    OF    CHILDREN 

tact  should  be  sterilized  shortly  before  they  are  used, 
by  steam  or  boiling  water. 

2.  That  it  be  cooled  immediately  after  leaving 
the  cows,  and  kept  at  as  low  a  temperature  as  possi- 
ble ;  to  be  efficient  this  should  not  be  above  50  °  F. 

Milk  produced  under  hygienic  conditions  and 
handled  with  special  care  is  sold  in  bottles  in 
most  cities  under  the  name  of  ^^certified,"  or  '^guar- 
anteed/' milk.  When  available  such  milk  should  be 
used  for  infants.  Of  course  the  extra  care  bestowed 
in  its  production  and  transportation  increases  the  cost 
of  the  milk,  but  the  best  will  usually  be  found  in  the 
end  to  be  the  cheapest. 

How  should  milk  he  handled  in  the  home  ivhen- 
obtained  fresh  from  the  cows? 

That  to  be  used  for  infants  should  be  strained 
through  a  thick  layer  of  absorbent  cotton  or  several 
thicknesses  of  cheese-cloth  into  quart  glass  jars  or 
milk  bottles  which  should  be  covered  and  cooled  im- 
mediately, best  by  placing  the  bottles  quite  up  to 
their  necks  in  ice  water  or  cold  spring  water,  where 
they  should  stand  for  at  least  half  an  hour.  That 
required  for  children  who  take  plain  milk  may  now 
be  poured  into  half-pint  bottles,  stoppered  with  cot- 
ton, and  put  in  the  ice-chest,  or  the  coolest  place  pos- 
sible.    This  first  rapid  cooling  is  very  important  and 


THE    SELECTION    AND    CARE    OF    MILK  61 

adds.rnuch  to  the  keeping  qualities  of  the  milk.  Milk 
loses  its  heat  very  quickly  when  cooled  in  water,  but 
very  slowly  when  it  is  simply  placed  in  a  cold  room. 
After  standing  four  or  -^ye  hours  the  top-milk  may 
be  removed ;  after  twelve  to  sixteen  hours  the  cream 
may  be  removed. 

Hoiv  should  milk  he  handled  when  bottled  milk 
is  purchased? 

It  should  be  cooled  as  just  described,  as  its  tem- 
perature is  usually  somewhat  raised  during  trans- 
portation. If  it  has  been  bottled  at  a  dairy,  the  cream 
or  the  top-milk  may  be  removed  after  an  hour  or 
two. 

Hoiu  should  milk  and  cream  he  handled  when 
they  are  purchased  in  hulk? 

Such  milk  should  never  be  used  for  infants  when 
it  is  possible  to  obtain  bottled  milk,  as  it  is  much 
more  liable  to  contamination.  It  should  be  poured 
at  once  into  sterilized  bottles  and  kept  in  the  coolest 
place  possible. 

What  are  the  important  things  to  he  secured  in 
nursery  refrigerators  f 

Absolute  cleanliness  is  essential ;  hence  the  inner 
portion  should  be  of  tile,  glass  or  metal.  Those  made 
entirely  of  metal  are  often  unsatisfactory  as  in  them 


62        THE    CAEE    AND    FEEDING    OF    CHILDEEN 

the  ice  melts  very  quickly.  If  the  ordinary  metal  re- 
frigerator sold  is  encased  in  a  wooden  box,  we  have 
the  best  form.  Another  easy  way  of  securing  the 
same  result  is  to  make  for  the  refrigerator  a  covering 
or  ^^cosey"  of  felt  or  heavy  quilting,  which  can  be 
easily  removed  when  wet  or  soiled. 

The  compartments  of  the  refrigerator  should  be 
so  arranged  that  the  bottles  of  milk  are  either  in 
contact  with  the  ice  or  very  near  it.  The  supply  of 
ice  should  be  abundant.  Often  the  amount  of  ice  is 
so  small,  and  the  bottles  so  far  away,  that  the  tem- 
perature of  the  milk  is  never  below  60°  or  65°  F. 
To  be  really  effective  a  refrigerator  should  have  a 
temperature  where  the  milk  is  placed  of  not  over 
50°  F.  The  temperature  should  be  tested  with  the 
nursery  thermometer  from  time  to  time  to  ascertain 
what  results  are  being  obtained.  Spoiled  milk  owing 
to  a  faulty  refrigerator  is  not  rarely  a  cause  of  acute 
illness  among  infants,  ^ext  to  the  feeding-bottles  it 
is  the  one  thing  in  the  nursery  which  should  receive 
the  closest  attention. 

Are  there  any  ohjections  to  the  use  of  vacuum 
(thermos)  hottles  for  heeping  the  milk  ivarm  or 
cold? 

They  are  often  useful  to  keep  milk  cold  while 
traveling.     They  should  not  be  used  to  keep  milk 


THE    MODIFICATION    OF    COW'S    MILK  63 


warm  as  for  night  feedings.  Milk  which  has  been 
kept -for  several  hours  at  the  feeding  temperature  is 
often  so  changed  as  to  make  the  baby  ill. 

THE  MODIFICATIOIS'  OF  COw's  MILK 

What  is  meant  hy  the  modification  of  cow's  milk? 
Changing  its  proportions  so  that  it  can  be  more 
easily  digested. 

Is  it  possible  to  modify  cow's  milh  so  as  to  mahe 
it  a  perfect  substitute  for  mother  s  milh? 

It  is  not.  Although  we  can  modify  cow's  milk 
so  that  the  gTcat  majority  of  infants  can  digest  it 
and  thrive  on  it,  it  must  be  remembered  that  there 
are  differences  which  cannot  be  wholly  overcome. 
There  are  certain  peculiar  qualities  in  mother's  milk 
which  cow's  milk  does  not  possess. 

How  is  this  milh,  whose  proportions  have  heen 
changed,  distinguished  from  the  unchanged  milh? 

The  changed  milk  is  usually  called  ^^modified 
milk" ;  the  original  unchanged  milk  is  known  as 
"plain  milk/'  "whole  milk,"  "straight  milk,"  or  is 
referred  to  simply  as  "milk." 

What  are  the  principal  differences  between  cow's 
milh  and  mother  s  milh? 

Cow's  milk  has  only  a  little  more  than  half  as 


64        THE    CARE    AND    FEEDING    OE    CHILDEEN 

much  sugar;  it  has  nearly  three  times  as  much  pro- 
tein and  salts;  its  protein  and  fat  are  different  and 
the  fat  much  more  difficult  of  digestion. 

Are  there  any  other  important  things  to  he  con- 
sidered f 

Yes;  mother's  milk  is  always  fed  fresh  and  is 
practically  sterile.  Cow's  milk  is  generally  kept 
twenty-four  hours  and  sometimes  much  lon2;er.  It 
is  to  a  greater  or  less  degTee  contaminated  by 
dirt  and  germs,  the  number  of  which  increases  rap- 
idly (1)  with  the  age  of  the  milk;  (2)  in  pro- 
portion to  the  amount  of  dust  or  dirt  which  enters  it ; 
(3)  with  any  increase  in  the  temperature  at  which 
the  milk  is  kept. 

It  is  just  as  important  for  success  in  infant  feed- 
ing that  these  conditions  receive  attention  as  that 
the  proportions  of  the  different  elements  of  the  milk 
are  right. 

Is  the  addition  of  lime  water  necessary  ? 

For  some  infants  with  feeble  or  disturbed  diges- 
tion the  addition  of  one  ounce,  sometimes  as  much  as 
two  ounces,  of  lime  water  to  each  twenty  ounces  of 
the  food  is  useful.  Its  routine  use  for  all  infants  is 
unnecessary. 


THE    MODIFICATION    OF    COW'S    MILK  65 

-How  is  the  sugar  best  increased? 
'  'By  adding  sngar  to  the  food;  three  level  table- 
spoonfuls  of  milk  sugar  to  each  twenty  ounces  of 
food  will  give  the  proper  quantity  for  the  first  three 
or  four  months.  This  will  make  the  proportion  about 
the  same  as  in  mother's  milk. 

How  should  the  sugar  he  ^prepared? 

Simply  dissolved  in  boiled  water ;  if  the  solution 
is  not  clear,  or  if  there  is  a  deposit  after  standing, 
it  should  be  filtered  by  pouring  through  a  layer  of 
absorbent  cotton,  half  an  inch  thick,  which  is  placed 
in  an  ordinary  funnel. 

Will  not  cane  {granulated)  sugar  answer  as  well 
as  milk  sugar  f 

Most  infants  appear  to  do  quite  as  well  wheii 
cane  sugar  is  used.  It  has  the  advantage  of  being- 
much  cheaper.  A  good  grade  of  milk  sugar  is  some- 
what expensive,  and  cheap  samples  are  apt  to  contain, 
impurities.  Moreover,  there  are  some  infants  in. 
whom  diarrhoea  is  excited  if  the  usual  amount  of; 
milk  sugar  is  given,  yet  who  bear  cane  sugar  very- 
well.  There  are  also  others  who  do  better  when  milk 
sugar  is  used. 

If  cane  sugar  is  used,  what  amount  should  he 
added  f 

Cane  sugar  is  heavier  than  milk  sugar ;  two  level 


66        THE    CARE    AND    TEEDING    OF    CHILDREN 

tablespoonfuls  to  each  twenty  ounces  of  the  food  is 
as  much  as  is  usually  desirable.  This  is  equivalent 
to  three  level  tahlespoonfuls  of  milk  sugar. 

May  any  other  sugar  he  used? 

Maltose  ^  (malt  sugar)  has  the  advantage  of  being 
very  easily  digested;  when  part  of  the  sugar 
given  is  maltose,  many  children  gain  more  rapidly 
in  weight  than  when  only  milk  sugar  or  cane  sugar 
is  used. 

Has  maltose  any  other  advantages? 
It  is  somewhat  more  laxative  than  other  sugars; 
it  is  therefore  useful  when  there  is  constipation. 

Are  there  any  disadvantages  attending  the  use 
of  maltose? 

It  is  not  well  borne  if  the  bowels  are  loose,  nor 
should  it  be  used  for  children  who  vomit  frequently 
or  habitually. 

^  Dry  preparations  of  maltose  available  are  "  dextri-maltose  " 
(Mead  Johnson  &  Co.),  and  " nahrzucker  "  (Soxhlet,  Germany). 
Liquid  preparations  are  Loeflund's  or  Borcherdt's  "malt  soup 
extract";  somewhat  less  expensive  bu"'j  rehable  is  the  "neutral 
maltose"  (Maltzyme  Co.,  Brooklyn). 

For  an  infant  six  months  old  from  two  teaspoonfuls  to  twe 
tahlespoonfuls  of  any  of  these  preparations  may  be  added  to  the 
food  for  the  day,  replacing  a  similar  quantity  of  milk  sugar. 

MeUin's  food  and  malted  milk  also  contain  a  large  percentage 
of  maltose. 


THE    MODIFICATION    OF    COW'S    MILK  67 

'   •  'Is  not  the  purpose  of  the  sugar  to  sweeten  the 
food  in  order  to  make  it  palatable? 

Not  at  all;  although  it  does  that,  its  real  use  is 
to  furnish  one  of  the  essential  elements  needed  for 
the  growth  of  the  body,  and  the  one  that  is  required 
by  young  infants  in  the  largest  quantity. 

How  do  we  hnow  that  this  is  so? 

By  the  fact  that  in  good  breast  milk  the  amount 
of  sugar  is  greater  than  that  of  the  fat,  protein,  and 
salts  combined. 

We  have  seen  that  cow's  milk  has  nearly  three 
thnes  a^  much  protein  (curd)  and  salts  as  mother  s 
milk.    How  are  these  to  he  reduced? 

By  diluting  the  milk. 

To  what  extent  is  dilution  desirable? 

For  the  early  weeks  the  milk  should  be  diluted 
twice;  after  three  months  diluting  once  is  usually 
sufficient. 

When  cow's  milk  has  been  diluted  in  this  way  does 
it  not  contain  much  less  fat  than  mother  s  milk  ? 

This  is  quite  true ;  but  on  account  of  the  difference 
in  the  two  fats  it  is  about  as  much  as  the  average 
child  can  digest. 

What  is  cream? 

Cream  is  often  spoken  of  as  if  it  were  the  fat  in 
milk.     It  is  really  the  part  of  the  milk  which  con- 


68        THE    CAEE    AND    FEEDING    OF    CHILDREN 

tains  most  of  the  fat.     It  differs  from  milk  chiefly 
in  containing  much  more  fat. 

In  what  ways  is  cream  now  ohtained? 

(1)  By  skimming,  after  the  milk  has  stood  "usu- 
ally for  twenty-four  hours;  this  is  known  as  "grav- 
ity cream.''  (2)  By  an  apparatus  called  a  separator; 
this  is  known  as  "centrifugal  cream" ;  most  of 
the  cream  now  sold  in  cities  is  of  this  kind.  The 
richness  of  any  cream  is  indicated  by  the  amount  of 
fat  it  contains. 

The  usual  gravity  cream  sold  has  from  16  to  20 
per  cent  fat.  The  cream  removed  from  the  upper 
part  (one  fifth)  of  a  bottle  of  milk  has  about  16  per 
cent  fat.  The  usual  centrifugal  cream  has  18  to  20 
per  cent  fat.  The  heavy  centrifugal  cream  has  35" 
to  40  per  cent  fat. 

Is  cream  more  digestible  than  milhf 
For  most  infants  it  is  much  less  so;  serious  dis- 
turbances of  digestion  are  often  caused  by   cream 
when  used  in  any  considerable  amount. 

What  is  top-milk  f 

It  is  the  thin  cream  removed  from  the  top  of  a 
bottle  of  milk  after  standing  a  few  hours. 

By  a  7-per-cent  top-milk  is  meant  one  which  con- 
tains 7  per  cent  fat.  'No  richer  top-milk  should  be 
used  in  infant  feeding. 


FOOD    FOE    HEALTHY    INFANTS  69 

.   /.How  can  7-per-cent  top-milk  he  obtained? 

From  a  good  average  milk,  by  removing  the  upper 
sixteen  ounces,  or  one-half. 

From  a  rich  Jersey  milk,  by  removing  the  upper 
twenty-two  ounces,  or  about  two-thirds. 

When  and  how  should  top-milh  he  removed? 

If  milk  fresh  from  the  cow,  or  before  the  cream 
has  risen,  is  put  into  bottles  and  rapidly  cooled,  the 
top-milk  may  be  removed  in  as  short  a  time  as  four 
hours.  In  the  case  of  bottled  milk  it  makes  little 
difFerence  if  it  stands  a  longer  time,  even  until  the 
next  day.  The  best  means  of  removing  it  is  by  a 
small  cream-dipper  ^  holding  one  ounce ;  although  it 
may  be  taken  off  by  a  spoon  or  siphon.  It  should  not 
be  poured  off. 


FOOD  FOR  HEALTHY  INFAI^TS  ^ 

In  deciding  upon  the  food  for  young  infants,  what 
are  the  different  points  to  he  determined? 

(1)  Amount  of  milk  and  sugar  required  for 
twenty-four  hours. 

1  Obtained  from  any  of  the  Walker-Gordon  milk  laboratories, 
from  James  Dougherty,  No.  411  West  59th  Street,  New  York, 
and  from  many  druggists.     Price,  20  cents. 

2  The  directions  and  formulas  given  in  the  following  pages  are 
intended  only  for  guidance  in  feeding  children  who  are  not  suf- 
fering from  any  special  disturbance  of  digestion;  directions  for 
Buch  conditions  are  given  in  a  later  chapter. 


70   THE  CABE  AND  FEEDING  OF  CHILDEEN 

(2)  The  volume  of  the  food  to  be  given  in  twenty- 
four  hours;  this  will  of  course  include  the  milk  and 
the  water  or  other  diluent  added. 

(3)  The  number  of  feedings  into  which  the  daily 
food  is  to  be  divided,  and  the  intervals  at  which  the 
food  is  given. 

Which  is  the  most  important? 

The  quantity  of  milk  and  sugar  which  are  given. 
This  must  be  sufficient  for  the  needs  of  the  body, 
which  are,  (1)  to  produce  heat;  (2)  to  repair  waste; 
(3)  to  provide  for  growth. 

What  happens  if  too  little  food  is  given? 

Since  heat  and  waste  must  first  be  provided  for, 
it  is  growth  which  suffers.  There  is  not  a  proper 
gain  in  weight. 

What  happens  if  too  much  food  is  given? 

The  excess  becomes  a  burden  to  the  child  and 
hinders  his  progress.  If  too  much  food  is  continued 
for  any  length  of  time,  serious  disturbances  of  di- 
gestion and  nutrition  are  apt  to  follow.  It  is  there- 
fore very  important  to  give  enough^  but  also  to  give 
no  more  than  the  child  actually  needs. 

How  do  we  Icnow  how  much  food  a  healthy  child 
needs? 

This  depends  upon  several  things.  Chiefly  upon 
his  weight,  his  size  and  his  activity. 


FOOD    FOR    HEALTHY    INFANTS  71 

•  ^  75  not  the  age  also  important? 

It  must  be  considered,  but  it  is  not  so  good  a  guide 
as  the  other  factors.  In  feeding  by  age  alone  a  small 
child  is  apt  to  get  too  much  food  and  a  large  child  too 
little  food.  A  child  of  three  months  weighing  twelve 
pounds  needs  more  food  than  a  child  who  is  three  days 
old  and  who  weighs  twelve  pounds;  and  a  child  of 
three  months  weighing  twelve  pounds  needs  more  food 
than  one  of  the  same  age  who  weighs  but  nine  pounds. 

Does  the  child's  activity  affect  his  need  of  food? 

This  is  important  and  usually  not  enough  con- 
sidered. A  laboring  man  working  out  of  doors  re- 
quires much  more  food  than  a  book-keeper;  and  a 
lively,  active,  energetic  infant  needs  more  food  than 
one  who  is  quiet  and  placid ;  sometimes  as  much  as  a 
third  or  quarter  more.  This  need  is  shown  in  the 
child's  appetite. 

Is  not  the  appetite  of  the  child  then  a  proper 
guide  f 

This  is  important  and  must  always  be  considered, 
but  alone  it  is  a  very  unreliable  guide.  For  many 
infants  will  regularly  take  much  more  food  than  they 
need,  if  it  is  offered. 

In  feeding  children  with  disturbed  digestion  can 
the  same  rules  he  applied? 

Only  to  a  limited  degree.    For  such  infants  other 


72    THE  CAEE  AND  FEEDING  OF  CHILDREN 

tilings  must  be  considered,  especially  the  nature  and 
severity  of  the  disturbance  of  digestion. 

About  how  much  food  does  a  healthy  child  re- 
quire  each  day? 

A  good  average  is  one  ounce  of  sugar  a  day, 
and  to  allow  one  and  one-half  ounces  of  milk 
to  each  pound  of  the  child's  weight ;  for  example,  a 
child  of  ten  pounds  would  require  fifteen  ounces  of 
milk,  one  of  twelve  pounds  eighteen  ounces,  etc.  Dur- 
ing the  first  two  weeks  of  life  somewhat  less  milk 
should  be  given. 

In  feeding  healthy  children,  if  the  proper  amounts 
of  milk  and  sugar  are  given,  does  it  ^natter  whether 
these  are  diluted  much  or  little? 

It  is  less  essential  than  the  amount  of  food  given, 
but  it  is  important.  The  body  requires  a  certain 
amount  of  fluid  daily  for  the  most  satisfactory  nu- 
trition. 

Too  great  a  dilution  of  the  food  makes  the  volume 
of  the  feeding  too  large,  overdistends  the  stomach  and 
often  produces  vomiting.  If  the  dilution  is  insuf- 
ficient, the  child  does  not  usually  digest  his  milk  so 
well,  and  besides  he  does  not  receive  as  much  fluid  as 
he  requires. 


FOOD    FOE    HEALTHY    INFANTS 


73 


Cannot  this  extra  fluid  he  given  hetiueen  meals  as 
v/ater? 

This  is  exactly  what  is  done  with  older  children; 
but  with  infants,  especially  young  infants,  it  is  usu- 
ally difficult,  and  sometimes  impossible,  to  make  them 
take  any  considerable  amount  of  water  apart  from 
the  food.  The  easiest  way  is  to  put  the  water  in  the 
food,  thus  diluting  it. 

What  is  the  simplest  way  of  modifying  millc  for 
infant  feeding? 

To  use  whole  milk  in  the  amounts  required,  di- 
luted according  to  the  principles  just  laid  down, 
adding  sugar,  etc. 

FORMULAS  FROM  WHOLE   MILK    (4-PER  CENT  FAT)   FOR  THE   EARLY 

MONTHS 


Formula. 

I. 

II. 

III. 

IV. 

V. 

VI. 

VII. 

VIII. 

IX. 

Milk. . 

oz. 

6 

61 

7 

7h 

8 

8^ 

9 

9h 

10 

Sugar . 

(( 

1 

1 

1 

1 

1 

1 

1 

1 

1 

Water. 

11 

14 

13i 

13 

m 

12 

11* 

11 

10* 

10 

Flour .  . 

.  tablesp's 

0 

20 

0 

20 

0 

0 

20 

0 

0 

0 

0 

1 

20 

20 

20 

20 

20 

20 

Note. — The  sugar  is  1  ounce  by  weight;  this  is  equivalent  to 
3  level  tablespoonfuls  of  milk  sugar  or  maltose,  and  2  level 
tablespoonfuls  of  granulated  sugar. 

The  flour  may  be  barley,  oat,  rice  or  wheat  flour,  or  arrowroot 
cooked  for  thirty  minutes  in  part  of  the  water  in  the  formula. 
Level  tablespoonfuls  should  be  used. 


74        THE    CAEE    AND    FEEDING    OF    CHILDKEN 

How  should  such  formulas  as  those  in  the  table 
he  used? 

Beginning  at  birth,  Formula  I  might  first  be 
given,  and  the  strength  of  the  food  increased  about 
once  a  week  up  to  ^o.  V,  after  that  every  two  weeks 
until  JSTo.  IX  is  reached. 

Such  a  formula  as  No.  IX  will  be  reached  by  an 
average  healthy  infant  at  about  three  months  of  age. 
After  this  the  next  group  of  formulas  may  be  used, 
but  the  increase  should  be  made  more  slowly,  about 
once  a  month  up  to  Xo.  XII,  then  about  every  two 
months,  reaching  Xo.  XIV  at  about  ten  months. 
This  may  be  continued  up  to  twelve  months. 


FORMULAS  FROM  WHOLE  MILK  FOR  THE  LATER  MONTHS 


FOKMULA. 

IX. 

X. 

XI. 

XII. 

XIII. 

XIV. 

Milk oz. 

Sugar " 

Water " 

Flour tablesp's 

10 
1 

10 
1 

11 

1 

2 

9 

12 

1 

2 

8 

13 

1 

2 

7 

14 

1 

2 

6 
2 

15 

5 
3 

20 

20 

20 

20 

20 

20 

If  top-milh  instead  of  whole  milk  were  used,  what 
changes  in  these  formulas  would  he  necessary? 

One  should  use  from  one-third  to  one-fourth  less 
milk  in  each  of  the  formulas,  otherwise  they  are  the 
same. 


FOOD    FOR    HEALTHY    INFANTS 


75 


FORMULAS   FROM   7-PER   CENT   TOP-MILK 


In  Formula  No.        I.  use    4 

II.    ' 

'     41 

"       III.    ' 

'     5 

IV.    ' 

'      51 

u     .       y_     c 

'     6 

VI.    ' 

'      6^ 

"      VII.    ' 

'     7 

"    VIII.    ' 

'       71 

'  2 

"       IX.    ' 

'     8 

X.    ' 

'     9 

( 

"       XI.    ' 

'      9^ 

"      XII.    ' 

'    10 

"    XIII.    ' 

'    101 

I 

"    XIV.    ' 

'  11 

Ik  in  20  ouncea. 


For  the  first  two  or  three  weeks  it  is  well  to  use 
the  formulas  of  the  whole  milk  series  and  then  those 
of  the  top-milk  series  beginning  with  I^o.  III.  The 
food  is  increased  in  strength  at  about  the  same  inter- 
vals in  both  series  of  formulas. 

After  E'o.  XIV  instead  of  taking  the  upper  16 
ounces,  one  may  take  off  20,  and  use  12  ounces  of 
this  in  20  of  food ;  then  take  off  24  and  use  13  ounces 
of  this  in  20  of  food;  then  use  the  whole  milk,  15 
ounces  in  20  of  food  which  is  the  same  as  'No.  XIY 
of  the  whole  milk  series. 


Under  what  circumstances  are  these  top-milk  for- 
mulas to  he  advised  f 

For  strong,  healthy  children  with  good  digestion. 
Such  children  are  usually  able  to  take  food  containing 


76        THE    CARE    AND    FEEDING    OF    CHILDEEN 

higher  fat  than  in  the  formulas  from  whole  milk  and 
thrive  better  when  it  is  given. 

Under  what  circumstances  are  formulas  from 
whole  milk  to  he  advised? 

For  most  infants  except  the  robust  class  just  de- 
scribed. 

There  is  a  great  advantage  in  having  the  two  dif- 
ferent gToups  of  formulas  for  use  with  different  types 
of  children. 

Under  what  circumstances  should  top-milk  formu- 
las not  he  used? 

They  should  not  be  given  to  infants  with  feeble 
digestion  or  to  those  suffering  from  acute  or  chronic* 
disturbances  of  digestion,  especially  if  vomiting  is 
present. 

Hoio  often  should  a  you7ig  hahy  he  fed? 

Every  three  hours  by  day  and  twice  at  night  (be- 
tween 6  p.  M.  and  6  a.  m.),  or  seven  times  in  the 
twenty-four  hours.  At  three  months  one  of  the  feed- 
ings between  6  p.  m.  and  6  a.  m.  may  be  omitted 
and  but  six  feedings  given  in  the  twenty-four  hours. 

^yhy  should  not  a  child  he  fed  more  frequently? 

It  takes  the  stomach  from  two  to  two  and  a  half 
hours  to  digest  a  feeding  of  cow's  milk,  even  when 
much  diluted.  When  the  food  is  made  stronger,  more 
time  is  required  for  digestion.     If  the  meals  are  too 


FOOD    FOE    HEALTHY    INFANTS 


77 


near  .together  the  second  one  is  given  before  the  first 
has  been  digested;  vomiting  and  indigestion  may  re- 
sult. Tlie  meals  should  be  far  enough  apart  to  give 
the  stomach  a  little  time  for  rest  before  the  next  feed- 
ing. A  common  cause  of  indigestion,  especially 
vomiting,  is  too  frequent  feeding. 

The  number  of  feedings  in  twenty-four  hours,  the 
quantity  for  a  single  feeding  and  the  daily  quantity 
are  given  in  the  following  table. 

SCHEDULE    FOR    HEALTHY   INFANTS   FOR  THE    FIRST    YEAR 


Age. 

Interval 

between 

meals 

by  day. 

Night 
feedings 
(6  p.  M.  to 

6  A.  M.) 

No.  of 

feedings 

in  24 

hours. 

Quantity 

for 

one 
feeding. 

Quantity 

for 

24 

hours. 

2d  to  7th  day 

2d  and  3d  weeks .... 

4th  to  6th  week 

7th  week  to  3  mos. .  . 

3  to  5  months 

5  to  7  months 

7  to  12  months 

Hours. 

3 
3 
3 
3 
3 
3 
4 

2 
2 
2 
2 
1 
1 
1 

7 
7 
7 
7 
6 
6 
5 

Ounces. 

1  -2 

2  -Sh 

3  -4 
3i-5 
4^-6 
51-61 
7  -81 

Ounces. 

7-14 
14-24 
21-28 
25-35 
27-36 
33-39 
35-43 

This  schedule  gives  the  averages  for  healthy  chil- 
dren. The  smaller  quantities  are  those  required  by 
small  children  whose  digestion  is  not  very  vigorous. 
The  larger  quantities  are  those  required  by  large  chil- 
dren with  strong  digestion;  in  very  few  cases  vdll 
it  be  advisable  to  go  above  these  figures. 


78        THE    CARE    AND    FEEDING    OF    CHILDEEN 

The  interval  is  reckoned  from  the  beginning  of 
one  feeding  to  the  beginning  of  the  next  one. 

Under  what  circumstances  should  the  interval 
between  the  feedings  he  lengthened  f 

When  there  is  gastric  indigestion  as  shown  by 
habitual  vomiting  or  the  regurgitation  of  food  long 
after  the  bottle  is  finished ;  also  when  the  appetite  is 
very  poor  so  that  the  infant  regularly  leaves  some  of 
its  food. 

When  should  the  interval  between  the  feedings 
he  shortened? 

This  is  done  much  too  frequently;  it  is  rarely 
advisable  to  feed  any  infant,  except  one  seriously  ill, 
oftener  than  the  time  put  down  in  the  schedule. 

In  the  series  of  fonnulas  given  in  the  table  the 
quantities  are  mentioned  for  mahing  only  twenty 
ounces  of  food.  How  should  it  be  prepared  when 
more  than  this  quantity  is  needed? 

It  is  equally  convenient  to  make  up  25,  30,  35, 
or  40  ounces  at  a  time.     To  make 


25  ounces  of  any  formula  add  one  quarter  more  of  each  ingredient 
30       "  "  "  "    one  half 

35       "  "  "  "    three  quarters   "         "  " 

40       "  "         "         "    as  much  "         "  " 


PEEPABATION    OF    COW'S    MILK    AT    HOME       79 


Thus,  if  using  Formula  V  one  would  take 

to  make  to  make  to  make 

25  ounces.  30  omices.  35  ounces. 

Milk ...  10    ounces.  Milk ....  12    ounces.  Milk ....  14  ounces. 

Sugar .  .   li       "  Sugar. . . .   1^       "  Sugar. ...   If       " 

Water..  15        "  Water...  18        "  Water...  21 

The  amount  of  water  need  not  be  calculated  in 
any  case,  but  after  measuring  carefully  the  other  in- 
gredients^ enough  water  should  be  added  to  bring  the 
total  up  to  the  amount  required. 


peepakatiojS"  of  cow's  milk  at  home 


What  articles  are  required  for  the  preparation  of 
cow's  milk  at  home? 

Feeding-bottles,  rubber  nipples,  an  eight-ounce 
graduated  measuring  glass,  a  glass  or  agate  funnel, 
bottle  brush,  cotton,  alcohol  lamp  or,  better,  a  Bun- 
sen  gas  burner,  a  tall  quart  cup  for  warming  bottles 
of  milk,  a  pitcher  for  mixing  the  food,  a  wide-mouth 
bottle  for  boric  acid  and  one  for  bicarbonate  of  soda, 
and  a  pasteurizer.  Later,  a  double  boiler  for  cooking 
cereals  will  be  needed. 

What  bottles  are  to  he  preferred? 
A  cylindrical  graduated  bottle  with  a  rather  wide 
neck,  so  as  to  admit  of  easy  washing,  and  one  which 


80        THE    CARE    AND    FEEDING    OF    CHILDEEN 

contains  no  angles  or  corners.  A  single  size  holding 
eight  ounces  is  quite  sufficient  for  use  during  the  first 
year.  All  complicated  bottles  are  bad,  being  difficult 
to  clean.  One  should  have  as  many  bottles  in  use  as 
the  child  takes  meals  a  day. 

How  should  bottles  he  cared  for? 

As  soon  as  they  are  emptied  they  should  be  rinsed 
with  cold  water  and  allowed  to  stand  filled  with  water 
to  which  a  little  bicarbonate  of  soda  has  been  added. 
Before  the  milk  is  put  into  them  they  should  be  thor- 
oughly washed  with  a  bottle  brush  and  hot  soap- 
suds and  then  boiled  or  placed  for  ten  minutes  in 
boiling  water. 

V^liat  sort  of  nipples  should  he  used? 

Only  simple  straight  nipples  which  slip  over  the 
neck  of  the  bottle.  Those  with  a  rubber  or  glass  tube 
are  too  complicated  and  very  difficult  to  keep  clean. 
Xipples  made  of  black  rubber  are  to  be  preferred. 
The  hole  in  the  nipple  should  not  be  so  large  that 
the  milk  will  run  in  a  stream,  but  just  large  enough 
for  it  to  drop  rapidly  when  the  bottle  with  the  nip- 
ple attached  is  inverted. 

How  should  nipples  he  cared  for? 
ISTew  nipples  should  be  boiled  for  five  minutes ; 
3ut  it  is  unnecessary  to  boil  them  every  day,  as  they 


PEEPARATION    OF    COW'S    MILK    AT    HOME       81 

soen  become  so  soft  as  to  be  almost  useless.  After 
using,  nipples  should  be  carefully  rinsed  in- cold  water 
and  kept  in  a  covered  glass  containing  a  solution  of 
borax  or  boric  acid.  At  least  once  a  day  they  should 
be  turned  inside  out  and  thoroughly  washed  with  soap 
and  water. 

What  sort  of  cotton  should  he  used? 

The  refined  non-absorbent  cotton  is  rather  better 
for  stoppering  bottles,  but  the  ordinary  absorbent  cot- 
ton will  answer  every  purpose.     ' 

Which  is  better,  the  Bunsen  hurner  or  the  alcohol 
lamp? 

If  there  is  gas  in  the  house,  the  Bunsen  burner 
is  greatly  to  be  preferred,  being  cheaper,  simpler,  and 
much  safer  than  the  alcohol  lamp.  If  the  lamp  is 
used,  it  should  stand  upon  a  table  covered  with  a 
plate  of  zinc  or  tin,  or  upon  a  large  tin  tray.  The 
safest  thing  to  use  in  the  nursery  is  the  snlall  electric 
heater. 

Give  the  directions  for  preparing  the  food  ac- 
cording to  any  of  the  above  formulas. 

The  nurse's  hands,  bottles,  tables,  and  all  utensils 

should  be  scrupulously  clean.     If  fiour  is  used  in 

the  food,  this  is  cooked  in  water  for  twenty  minutes 

and  then  sufficient  boiled  water  added  to  bring  the 

6 


82       THE    CARE    AND    FEEDING    OF    CHILDREN 

total  quantity  up  to  that  called  for  in  tlie  formula. 
When  this  has  cooled,  the  milk  and  sugar  should  be 
added  and  the  whole  mixed  in  a  pitcher.  The  food 
for  twenty-four  hours  is  always  to  be  prepared  at 
one  time.  The  amount  needed  for  each  feeding  is 
put  in  a  separate  bottle ;  bottles  are  then  stoppered 
with  cotton  and  placed  at  once  in  the  ice-box  or  the 
food  is  first  pasteurized  according  to  directions  given 
elsewhere. 


DIRECTIOIS^S   FOE  FEEDING  INFANTS 

How  should  the  bottle  he  prepared  at  feeding 
time  ? 

It  should  be  taken  from  the  ice  chest,  and  warmed 
by  standing  in  warm  water  which  is  deep  enough  to 
cover  the  milk  in  the  bottle ;  it  should  then  be  thor- 
oughly shaken  and  the  nipple  adjusted;  the  nurse 
should  see  that  the  hole  in  the  nipple  is  not  too  large 
nor  too  small. 

Hoiv  may  the  temperature  of  the  milk  he  tested? 

Never  by  putting  the  nipple  in  the  nurse's  mouth. 
Before  adjusting  the  nipple,  a  teaspoonful  may  be 
poured  from  the  bottle  and  tasted,  or  a  few  drops 
may  be  poured  through  the  nipple  upon  the  inner 
surface  of  the  wrist,  where  it  should  feel  quite  warm 


DIRECTIONS    FOE    FEEDING    INFANTS  83 


but  .never  hot;  or  a  thennometer  may  be  placed  in 
the  water  in  wbicb  the  bottle  stands.  A  dairy  ther- 
mometer should  be  used,  and  the  temperature  of  the 
water  should  be  between  98°  and  105*^  F. 

What  is  a  simple  contrivance  for  Iceeping  the 
milk  warm  during  feeding? 

A  small  flannel  bag  with  a  draw  string  may  be 
slipped  over  the  bottle. 

In  what  position  should  an  infant  taJce  its  hottlef 
For  the  first  two  or  three  months  it  is  better,  ex- 
cept at  night,  when  it  may  be  undesirable  to  take  the 
infant  from  its  crib,  that  it  be  held  on  the  nurse's 
arm  during  the  feeding;  later  it  may  lie  on  its  side 
in  the  crib  provided  the  bottle  is  held  by  the  nurse 
until  it  has  been  emptied ;  otherwise  a  young  infant 
readily  falls  into  the  bad  habit  of  alternately  sucking 
and  sleeping,  and  often  will  be  an  hour  or  more  oyer 
its  bottle. 

How  much  time  should  he  allowed  for  one  feed- 
ing? 

ISTot  more  than  twenty  minutes.  The  bottle  should 
then  be  taken  away  and  not  given  until  the  next  feed- 
ing time.  Under  no  circumstances  should  an  infant 
form  the  habit  of  sleeping  with  the  nipple  in  its. 
mouth.     A  sleepy  infant  should  be  kept  awake  by 


84       THE    CAEE    AND    FEEDING    OE    CHILDEEN 


gentle  shaking  until  the  food  is  taken,  or  the  bottle 
should  be  removed  altogether. 

Should  an  mfant  he  iiilayed  with  soon  after  feed- 
ing? 

On  no  account ;  snch  a  thing  frequently  causes 
vomiting  and  sometimes  indigestion.  After  feeding 
the  infant  may  be  lifted  from  his  crib,  placed  over 
the  nurse's  shoulder  and  patted  for  a  moment  to  allow 
him  to  bring  up  the  air  that  he  has  swallowed.  He 
•should  then  be  placed  in  his  crib  and  allowed  to  lie 
quietly  without  rocking,  being  disturbed  as  little  as 
possible  either  by  the  nurse,  the  parents  or  visitors. 


OENEEAL    RULES    EOE    GUIDANCE    IN    THE   USE    OF    THE 
FOEMULAS  GIVEN 

It  should  again  be  emphasized  that  these  formulas 
are  not  intended  for  sick  children  nor  for  those  suf- 
fering from  any  marked  s^Ttiptoms  of  indigestion. 
For  such  infants  special  rules  are  given  later. 

What  should  he  the  guide  in  deciding  upon  a  for- 
mula with  ivhich  to  he  gin  for  a  child  ivho  is  to  he 
artificially  fed? 

The  age  and  the  weight  are  of  importance,  but  the 
best  guide  is  the  condition  of  the  child's  digestive  or- 


GENERAL    EULES    FOR    GUIDANCE  85 

gafi-s.  One  should  alwaj^s  begin  with  a  weak  formula, 
particularly,  (1)  with  an  infant  previously  breast 
fed;  (2)  with  one  just  weaned,  as  a  child  who  has 
never  had  cow's  milk  must  at  first  have  weaker  pro- 
portions than  the  age  and  the  weight  would  seem  to 
indicate;  (3)  with  infants  whose  power  of  digestion 
is  unknown.  If  the  first  formula  tried  is  weaker 
than  the  child  can  digest,  the  food  can  be  strength- 
ened every  three  or  four  days  until  the  child's  capac- 
ity is  reached.  On  the  contrary,  if  the  food  is  made 
too  strong  at  first,  an  attack  of  indigestion  will 
probably  follow. 

How  should  tlie  food  he  increased  in  strength  f 
The  first  essential  is  that  it  be  done  very  gradu- 
ally; abru]3tly  increasing  the  food  usually  causes  a 
disturbance  of  digestion. 

It  is  never  wise  to  advance  more  rapidly  in 
strengthening  the  food  than  from  one  formula  to  the 
next  one  in  any  of  the  series  given ;  with  some  in- 
fants it  is  better  to  make  the  steps  of  increase  only 
half  as  great  as  those  indicated. 

How  rapidly  should  the  food  he  increased  in 
quantity  ? 

The  increase  should  not  be  more  than  a  quarter  of 
an  ounce  in  each  feeding;  never  oftener  than  every 
three  days  and  usually  not  oftener  than  once  a  week. 


86        THE    CAEE    AXD    FEEDING    OF    CHILDEEJT 

When  should  the  food  he  increased? 

In  the  early  weeks  an  increase  may  be  necessary 
every  few  days ;  in  the  later  months  sometimes  the 
same  formula  may  be  continued  for  two  or  three 
months.  It  is,  however,  impossible  to  give  a  definite 
rule  as  to  time.  One  cannot  say  with  any  child  that 
an  increase  is  to  be  made  every  week  or  every  two 
weeks.  A  much  better  guide  is  the  condition  of  the 
digestion  as  shown  by  the  child's  appetite,  the  char- 
acter of  the  stools,  the  sleep,  and  the  general  disposi- 
tion. 

The  signs  indicating  that  the  food  should  be  in- 
creased are,  that  the  infant  is  not  satisfied,  not  gain- 
ing in  weight,  but  is  digesting  well,  i.  e.,  not  vomit- 
ing, and  having  good  stools.  One  should  not  increase 
the  food,  however,  so  long  as  the  child  seems  perfectly 
satisfied  and  is  gaining  from  four  to  six  ounces  a 
week,  even  though  both  the  quantity  and  the  strength 
of  the  food  are  considerably  below  the  average;  nor 
should  the  food  be  increased  if  the  child  is  gaining 
from  eight  to  ten  ounces  a  week,  even  if  he  seems 
somewhat  hungry.  The  appetite  is  not  always  a  trust- 
worthy guide.  Many  infants  will  habitually  take 
more  food  than  thev  are  able  to  disrest  and  it  is  not 
safe  to  give  an  infant  more  and  more  food  just  be- 
cause he  will  take  it.  The  purpose  should  not  be 
to  see  how  much  food  a  child  can  be  induced  to  take, 


GENEEAL    EULES    FOE    GUIDANCE  87 

but  to  see  how  well  lie  can  be  kept.  The  ultimate 
results  of  overfeeding  are  serious  disturbances  of  di- 
gestion. 

How  can  one  "know  whether  the  strength  or  the 
quantity  of  the  food  should  he  increased? 

In  the  early  weeks  it  is  well  first  to  increase  the 
strength  of  the  food,  the  next  time  to  increase  the 
quantity,  then  the  strength  again,  etc.  After  the 
fourth  or  fifth  month,  the  quantity,  chiefly,  should  be 
increased. 

If  a  slight  disturhance  or  discomfort  occurs  after 
the  food  has  heen  strengthened,  is  it  hest  to  go  hack 
to  the  weaker  formula  or  to  persist  with  the  new  one  ? 

Symptoms  of  minor  discomfort  are  seen  for  a  day 
or  two  with  many  infants  after  an  ordinary  increase 
in  food;  but  in  most  cases  an  infant  soon  becomes 
accustomed  to  the  stronger  food  and  is  able  to  digest 
it.  If,  however,  the  symptoms  of  disturbance  are 
marked,  one  should  promptly  go  back  to  the  weaker 
formula.     The  next  increase  should  be  a  smaller  one. 

Should  one  he  disturhed  if  for  the  first  two  or 
three  weeks  of  artificial  feeding  the  gain  in  weight  is 
very  slight  or  even  if  there  is  none  ? 

ISTot  as  a  rule.  If  the  infant  does  not  lose  weight,, 
is  perfectly  comfortable,  sleeps  most  of  the  time,  and 


88        THE    CAEE    AXD    FEEDIXG    OF    CHILDEEX 

does  not  suffer  from  any  s;\Tiiptonis  of  indigestion, 
such  as  colic,  vomiting,  etc.,  one  may  be  sure  tliat 
all  is  going  well  and  that  the  infant  is  becoming  used 
to  his  new  food.  As  the  child's  appetite  improves  and 
his  digestion  is  stronger,  the  food  may  be  increased 
every  few  days  and  very  soon  the  gain  in  weight  will 
come  and  will  then  be  continuous.  If,  however,  the 
scales  are  watched  too  closely  and,  because  there  is 
only  a  slight  gain  in  weight  or  none  at  all,  the  food  is 
rapidly  increased,  an  acute  disturbance  of  digestion  is 
pretty  certain  to  follow. 

Is  not  constijMtion  likely  to  occur  if  the  child  is 
on  a  very  weak  food? 

It  is  very  often  seen  and  is  due  simply  to  the 
small  ^amount  of  residue  in  the  intestine.  But  if  the 
bowels  move  once  a  day,  one  should  not  be  disturbed 
even  when  the  movements  are  small  and  somewhat 
dry.  As  the  food  is  gradually  strengthened,  this  con- 
stipation soon  passes  off;  while  if  injections,  suppos- 
itories, or  cathartics  are  used  to  produce  freer  move- 
ments, the  functions  of  the  bowels  are  likely  to  be 
disturbed. 

U'iider  what  circumstances  should  the  food  he  re- 
duced? 

Whenever  the  child  becomes  ill  from  any  cause 


GENERAL    RULES    FOR    GUIDANCE  89 

whatever^  or  whenever  anj  marked  symptoms  of  indi- 
gestion arise. 

How  may  this  he  done? 

If  the  disturbance  is  only  a  moderate  one  and  the 
food  has  been  made  up  for  the  day,  one-third  may  be 
poured  off  from  the  top  of  each  bottle  just  before  it 
is  given,  and  this  quantity  of  food  replaced  by  the 
same  amount  of  boiled  water. 

If  the  disturbance  is  more  severe,  the  food  should 
be  immediately  diluted  by  at  least  one-half  and  at 
the  same  time  the  quantity  given  should  be  reduced. 

For  a  severe  acute  attack  of  indigestion  the  regTi- 
lar  food  should  be  omitted  altogether  and  only  water 
given  until  the  doctor  has  been  called. 

//  the  food  has  heen  reduced  for  a  disturbance 
of  digestion,  how  should  one  return  to  the  original 
formula  f 

While  the  reduction  of  the  food  should  be  im- 
mediate and  considerable,  the  increase  should  be  very 
gradual.  After  a  serious  attack  of  acute  indigestion, 
when  beginning  with  milk  again,  it  should  not  be 
made  more  than  one-fourth  the  original  strength,  and 
from  ten  days  to  two  weeks  should  pass  before  the 
child  is  brought  back  to  his  original  food,  which 
should  be  done  very  gradually.     It  is  surprising  how 


90        THE    CAEE    AXD    FEEDING    OF    CHILDEEN 

long  a  time  is  required  with  young  infants  before 
they  completely  recover  from  an  attack  of  acute  indi- 
gestion, even  though  it  did  not  seem  to  be  very  severe. 
The  second  disturbance  always  comes  from  a  slighter 
cause  than  the  first  one. 


EEGULAEITT  IN  FEEDII^G 

How  can  a  haby  he  taught  to  he  regular  in  its 
Tiahits  of  eating  and  sleeping'^ 

By  always  feeding  at  regular  intervals  and  put- 
ting to  sleep  at  exactly  the  same  time  every  day  and 
evening. 

When  should  regular  training  he  begun? 
During  the  first  week  of  life. 

Should  a  hahy  he  walcened  to  he  nursed  or  fed  if 
sleeping  quietly  f 

Yes,  for  a  few  days.  This  will  not  be  required 
long,  for  with  regular  feeding  an  infant  soon  wakes 
regularly  for  its  meal,  almost  upon  the  minute. 

Should  regularity  in  feeding  he  hept  up  at  night 
as  well  as  during  the  day? 

With  a  very  young  infant  up  to  nine  or  ten 
o'clock;  with  older  infants,  only  up  to  six  o'clock; 
after  that  time  they  should  be  allowed  to  sleep  as  long 


OVERFEEDING  91 


as  "tkey  will,  and  the  night  feeding  not  given  unless 
they  wake  for  it. 

At  what  age  may  a  well  hahy  go  without  food 
from  10  p.  M.  to  6  or  7  a.  m.  f 

Usually  at  three  months,  and  always  at  five  or  six 
months.  E'ight  feeding  is  one  of  the  most  frequent 
causes  of  wakefulness  and  disturbed  sleep. 

OVEEFEEDING 

What  is  meant  by  overfeeding? 

Giving  an  infant  too  much  food ;  either  too  much 
at  one  time  or  too  frequently.  Overfeeding,  espe- 
cially at  night,  is  the  most  common  of  all  mistakes 
in  artificial  feeding. 

Is  not  an  infant's  natural  desire  for  food  a  proper 
guide  as  to  the  quantity  to  he  given? 

The  appetite  of  a  perfectly  normal  infant  usu- 
ally is;  but  overeating  is  a  habit  gradually  acquired 
and  may  continue  until  twice  as  much  food  as  is 
proper  is  taken  in  the  twenty-four  hours.  This  habit 
is  most  frequently  seen  in  infants  whose  digestion 
is  not  quite  normal ;  because  of  the  temporary  relief 
from  discomfort  experienced  by  taking  food  into  the 
stomach,  they  often  appear  to  be  hungry  the  greater 
part  of  the  time,  especially  at  night. 


92        THE    CAEE    AND    FEEDING    OF    CHILDKEN 

What  are  the  causes  of  overfeeding? 

The  most  common  one  is  the  hahit  of  watching 
the  weight  too  closely,  and  the  conviction  on  the  part 
of  the  mother  or  nnrse  that,  because  a  child  is  not  so 
large  nor  gaining  so  rapidly  as  some  other  infant 
of  the  same  ao'e,  more  food  or  stronger  food  should 
be  given. 

What  harm  results  from  overfeeding f 
All  food  taken  in  excess  of  what  a  child  can  di- 
gest becomes  a  bnrden  to  him.  The  food  lies  in  the 
stomach  or  bowels  undigested,  ferments,  and  causes 
wind  and  colic.  When  overfeeding  is  longer  con- 
tinuedj  serious  disturbances  of  digestion  are  soon 
produced.  The  infant  is  restless,  fretful,  constantly 
uncomfortable,  sleeps  badly,  stops  gaining  and  may 
even  lose  in  weight.  Such  symptoms  may  lead  to 
the  mistaken  conclusion  that  too  little  food  is  given, 
and  it  is  accordingly  increased,  when  it  should  be 
diminished. 

What  are  the  earliest  signs  of  overfeeding? 

That  an  infant  does  not  quite  finish  his  bottle. 
If  this  happens  but  once  in  a  few  days  it  is  not  im- 
portant ;  but  when  it  occurs  with  almost  every  feed- 
ing it  is  a  warning  which  should  be  heeded.  Under 
■Qo  circumstances  should  an  infant  be  coaxed  to  take 


COMMON    MISTAKES    IN    MILK    MODIFICATION     93 

more  -food,  when  lie  clearly  does  not  want  it.      (See 
Loss  of  Appetite,  p.  94.) 


COMMON   MISTAKES   IN   MILK   MODIFICATION   AND 
INFANT    FEEDING 

I.  In  formulas  calling  for  a  certain  number  of 
ounces  of  top-milk,  the  mistake  is  made  of  removing 
only  the  number  of  ounces  needed  for  the  formula. 
The  proper  way  is  to  remove  the  amount  required  to 
secure  a  top-milk  of  the  desired  strength  and  then  to 
take  of  this  the  number  of  ounces  needed  in  the 
formula. 

II.  A  rich  Jersey  milk  is  used  as  if  it  were  ordi- 
nary milk.  The  formulas  given  in  this  book  are 
chiefly  calculated  on  the  basis  of  a  good  average  milk 
which  contains  about  4  per  cent  fat.  Many  persons 
have  the  idea  that  the  richer  the  milk,  the  more  rap- 
idly the  child  will  gain  in  weight,  and  hence  the 
superiority  of  such  milk  for  infant  feeding.  While 
it  is  true  that  some  children  taking  a  very  rich  milk 
may,  for  a  time,  gain  rapidly  in  weight,  yet  sooner 
or  later,  serious  disturbances  of  digestion  are  nearly 
always  produced. 

III.  The  food  is  increased  too  rapidly,  particu- 
larly after  some  disturbance  of  digestion.     If,  in  an 


94        THE    CAEE    AXD    FEEDING    OF    CHILDEEN 

infant  tliree  or  four  months  old,  an  attack  of  some- 
what acute  indigestion  occurs,  the  food  should  sel- 
dom be  given  again  in  full  strength  before  two  or 
three  weeks.  Otherwise  it  generally  happens  that 
the  attack  of  indigestion  is  very  much  prolonged  and 
much  loss  in  weight  occurs. 

IV.  When  s^Tuptoms  of  indigestion  occur,  the 
food  is  not  reduced  rapidly  enough.  Indigestion  usu- 
ally means  that  the  organs  are,  for  the  time,  unequal 
to  the  work  imposed.  If  the  food  is  immediately  re- 
duced by  one-half,  the  organs  of  digestion  soon  re- 
gain their  power  and  the  disturbance  is  short.  In 
every  case  the  amount  of  reduction  should  depend 
upon  the  degree  of  the  disturbance. 


THE    CHANGES    IN    THE    EOOD    REQTJIEED    BY    SPECIAL 
SYMPTOMS  OR  CONDITIONS 

EOSS   OF  APPETITE 

What  is  to  he  done  ivJien,  without  any  other  signs 
of  illness,  a  child's  appetite  gradually  fails? 

This  is  often  the  result  of  a  long  period  of  over- 
feeding or  the  use  of  milk  too  rich  in  fat.  If  in  all 
other  respects  the  child  seems  well  and  simply  does 
not  want  his  food,  it  should  be  offered  at  regular 


VOMITING  95 


hours,  but  not  more  frequently ;  on  no  account  should 
he  be  coaxed,  much  less  forced,  to  eat,  even  though  he 
takes  only  one-half  or  one-third  the  usual  quantity. 
The  intervals  between  feedings  should  not  be  short- 
ened but  rather  lengthened.  Often,  with  a  child  a 
year  old,  it  is  necessary  for  a  time  to  reduce  the  num- 
ber of  feedings  to  four  or  even  three  in  twenty-four 
hours.  Water,  however,  may  be  offered  at  more  fre- 
quent interv^als.  The  food  should  be  weakened  rather 
than  strengthened.  'No  greater  mistake  can  be  made 
than,  because  so  little  is  taken,  coaxing  or  forcing 
food  at  short  intervals  through  fear  lest  the  child  may 
lose  weight. 

VOMITIl^a 

Why  is  it  that  an  infant  so  often  vomits  some  of 
its  food  ivithin  a  feio  moments  after  finishing  its 
bottle? 

There  are  many  causes  besides  the  composition 
of  the  food.  Usually  the  child  is  fed  too  often,  or 
is  given  too  much  at  a  time ;  or  the  food  is  taken  too 
rapidly  (in  Rye  or  six  minutes)  when  the  hole  in 
the  nipple  is  very  large;  or  too  slowly  (twenty-five 
to  thirty  minutes)  when  the  hole  is  very  small.  In 
the  latter  case  the  child  often  swallows  a  great  deal 
of  air  and  may  continue  to  spit  up  small  quantities 


96        THE    CARE    AND    FEEDING    OF    CHILDEEN 

of  food  until  he  is  relieved.     It  may  be  because  the 
child  is  jounced  or  rocked  or  handled  after  feeding. 

How  are  these  conditions  to  he  remedied? 

Xo  vomiting  baby  should  be  fed  oftener  than 
every  three  hours  and  for  many  the  interval  should 
be  four  hours,  even  as  early  as  the  third  or  fourth 
month.  The  hole  in  the  nipple  should  allow  the  child 
to  get  his  food  in  fifteen  to  twenty  minutes;  better 
more  rapidly  than  more  slowly. 

After  taking  his  bottle  the  child  should  be  lifted 
and  placed  over  the  nurse's  shoulder  to  allow  him  to 
get  up  the  gas.  Often  it  is  well  to  do  this  in  the 
middle  of  the  feeding  as  well  as  at  its  close.  After 
the  gas  has  been  brought  up  the  child  should  be 
placed  in  his  crib  and  left  quietly. 

JVliat  are  the  changes  in  the  food  recjuired  hy 
habitual  vomiting,,  regurgitation  or  frequently  spit- 
ting up  of  small  quantities  of  food  hetiueen  feedings? 

In  such  conditions  formulas  from  top-milk  should 
never  be  used,  but  rather  those  from  Avhole  milk. 
Two  ounces  of  lime  water  may  be  added  to  each 
twenty  ounces  of  food,  replacing  the  same  amount  of 
plain  water. 

In  cases  not  improved  by  these  changes  it  may  be 
necessary  to  reduce  the  fat  in  the  milk  still  further. 
This  is  especially  true  if  the  milk  used  is  very  rich. 


VOMITING  97 


Under  these  circumstances  one  should  remove  some 
of  the  cream  from  the  top  of  the  bottle  before  shak- 
ing it. 

How  much  cream  should  he  removed? 

At  first  four  ounces  may  be  taken  off,  after  which 
the  bottle  is  shaken  and  the  balance  used  as  in  the 
formulas  from  whole  milk.  After  a  few  days  if  the 
symptoms  improve  only  three  ounces  of  cream  need 
be  removed.  After  a  few  days  longer  only  two 
ounces  are  removed,  then  only  one  ounce  and  finally 
the  child  is  brought  back  to  the  mixtures  from  whole 
milk. 

Is  vomiting  often  increased  hy  the  sugar? 

This  is  not  likely  with  milk  sugar  if  only  the 
quantity  mentioned  in  the  formulas  is  used.  How- 
ever, the  use  of  much  cane  sugar  or  of  maltose  often 
aggravates  the  vomiting.  Therefore  under  these  con- 
ditions the  use  of  any  of  the  malted  foods  should  be 
carefully  avoided. 

What  changes  should  he  made  in  the  quantity 
given  at  a  feeding? 

It  is  difficult  to  lay  down  an  absolute  rule.  Usu- 
ally a  small  quantity  of  a  strong  food  is  better  than 
a  large  quantity  of  a  weak  food.  But  one  should  not 
give  more  than  is  advised  in  the  schedule  for  the  age 


98       THE    CARE    AXD    FEEDING    OF    CHILDREN 

of  the  child.     To  give  somewhat  smaller  quantities  is 
sometimes  useful^  but  often  this  is  of  no  assistance. 

GAS,   rLATULE]S"CE  AJS^D   COLIC 

What  are  the  causes  of,  and  food  changes  re- 
quired by  much  gas  in  the  stomach,  leading  to  dis- 
tention and  eructations  (belching)  of  gas  and  often 
of  sour  food  or  fluid? 

This  is  often  associated  with  habitual  vomiting 
and  is  due  to  similar  causes.  It  is  a  symptom  of  in- 
digestion. It  is  generally  associated  with  gastric 
fermentation  and  is  made  worse  bv  food  containino; 
high  sugar  or  high  fat ;  with  such  sjnuptoms  both 
should  be  reduced.  Most  of  the  gas  in  the  stomach 
is  air  which  has  been  swallowed.  Air  is  swallowed 
not  only  when  food  is  taken,  but  by  many  infants 
at  other  times. 

What  changes  shoidd  be  made  in  the  food  when 
there  is  habitual  flatulence  and  colic? 

Flatulence  occurs  when  there  is  excessive  forma- 
tion of  gas  in  the  intestines  or  when  the  air  swal- 
lowed passes  on  into  the  bowels.  If  this  is  readily 
expelled  the  child  suffers  no  great  discomfort ;  but  if 
not,  some  distention  of  the  bowel  takes  place  and 
colic  results. 


CONSTIPATION  99 


'  .'Botli  these  conditions  are  greatly  aggravated  by 
constipation,  and  to  relieve  the  constipation  is  often 
the  best  means  of  controlling  them. 

The  gas  usually  arises  from  faulty  digestion  of 
the  sugars  or  starch,  and  any  of  these  elements  of 
the  food  may  need  to  be  reduced,  particularly 
the  starch,  which  in  many  cases  should  be  omitted 


altogether. 


COTifSTIPATIO]!^ 


Whai  changes  sJioidd  he  made  in  the  food  for 
chronic   constipation? 

l^othing  should  be  done  if  there  is  one  good 
stool  a  day.  Such  a  condition  cannot  be  called  con- 
stipation. The  constipation  of  the  first  weeks  of  life 
has  been  already  referred  to  (page  88)  ;  it  usually 
disappears  as  the  food  is  gradually  strengthened. 

Constipation  is  rather  more  frequent  in  infants 
fed  upon  formulas  from  whole  milk  than  upon  those 
from  top-milk.  A  change  to  the  latter  may  at  times 
be  beneficial.  The  chief  element  in  the  food,  how- 
ever, which  influences  the  bowels  is  the  sugar.  The 
daily  amount  of  milk  sugar  may  be  increased  by  one 
or  two  level  tablespoonfuls  over  that  usually  given, 
or  part  of  the  milk  sugar  may  be  replaced  by  maltose,, 
which  is  more  laxative.  A  reduction  in  the  milk 
and  the  use  earlier  or  in  larger  amount  of  gruel,. 


100      THE    CARE    AND    FEEDING    OF    CHILDREN 

■especially  that  of  oatmeal,  is  sometimes  helpful. 
In  more  obstinate  cases  one-half  or  one  teaspoon- 
ful  of  the  milk  of  magnesia  may  be  added  to  the 
daily  food.  The  amount  given  may  gradually  be 
reduced  until  finally  it  is  discontinued.  To  infants 
over  six  months,  fruit  juice  may  be  given;  and  to  all 
constipated  infants  water  should  be  given  freely  be- 
tween feedings. 

HOT    WEATHEK 

What  special  modifications  are  required  during 
very  hot  weather? 

During  the  warm  season  it  is  well  to  make  the 
proportion  of  fat  less  than  during  cold  weather. 
During  periods  of  excessive  heat  it  should  be  much 
less.  The  fat  is  reduced  by  using  formulas  from 
whole  milk  in  place  of  the  7-per-cent  milk.  At  such 
times  also  the  usual  food  should  be  diluted  and  water 
given  freely  between  the  feedings. 

]S"0    GAIE    T^    WEIGHT 

What  changes  should  he  made  in  the  food  of  a 
child  who,  with  all  the  signs  of  good  digestion,  gains 
very  little  or  not  at  all  in  weight  f 

If  the  child  seems  hungTy  the  quantity  of  food 


NO    GAIN    IN    WEIGHT  101 

may  be  increased,  or  the  food  may  be  made  stronger 
ty  using  the  next  higher  formula  of  the  series.  If 
the  child  is  not  hungry  it  is  unwise  to  attempt  to  in- 
crease either  the  quantity  or  the  strength  of  the^ 
food ;  for  a  child  thrives,  not  upon  what  he  swallows, 
but  upon  w^hat  he  digests.  Coaxing  or  forcing  the- 
child  in  order  to  increase  the  amount  of  food  taken 
is  almost  certain  to  upset  digestion  and  cause  actual 
loss  in  weight. 

In  general,  such  children  as  w^e  are  considering- 
do  best  upon  milk  formulas  which  are  low  in  fat,. 
i.  e.,  those  from  whole  milk  or  even  from  partially 
skim^med  milk  (page  97)  rather  than  those  from 
top-milk,  and  to  give  at  the  same  time  larger  quan- 
tities of  both  sugar  and  starch  than  usual.  The- 
amount  of  flour  may  often  be  made  one  and  one- 
half  times  or  even  twice  that  usually  given.  With- 
out reducing  the  quantity  of  milk  sugar  one  of  the 
preparations  of  maltose  (page  QQ)  may  be  added, 
beginning  with  two  teaspoonfuls  and  gradually  in- 
creased to  two  tablespoonfuls  daily,  unless  vomiting 
or  looseness  of  the  bowels  is  produced. 

It  is  also  important  to  look  after  the  other  fac- 
tors in  the  child's  life, — the  care,  sleep,  fresh  air, 
etc.,  for  with  these  rather  than  with  the  food  the 
trouble  often  lies. 


102  THE  CARE  AXD  FEEDING  OF  CHILDEEN 


What  sliould  he  done  ivitli  infants  ivlio  in  spite  of 
all  the  usual  variations  in  the  milJc  continue  to  liave 
symptoms  of  discomfort  or  indigestion  and  do  not 
thrive  f 

Except  inmates  of  institutions,  who  form  a  class 
by  themselves,  most  infants  who  receive  proper  care 
thrive  upon  milk  if  the  proportions  suited  to  the 
digestion  are  given.  Still  there  are  some  who  do  not. 
The  nutrition  of  such  is  always  a  matter  of  difficulty. 

If  a  wet-nurse  is  available  the  employment  of  one 
is  the  thing  most  likely  to  succeed,  particularly  if 
the  infant  is  under  three  or  four  months  old.  Com- 
plete wet-nursing  may  be  necessary  for  a  few  weeks ; 
after  this  partial  nursing  is  usually  sufficient. 

Some  infants  thrive  upon  toiled  milk  who  seem 
to  be  unable  to  digest  raw  milk;  both  therefore 
.should  be  tried. 

Success  sometimes  follows  a  change  to  condensed 
milk  (page  117).  It  is  more  likely  to  agree  when 
the  symptoms  are  chiefly  intestinal  (colic,  flatulence, 
•constipation,  undigested  stools  or  diarrhoea)  than 
when  the  symptoms  are  chiefly  gastric  (vomiting,  re- 
gurgitation, etc.).  Condensed  milk  should  not  be 
continued  indefinitely;  after  a  period  varying  from 
a  few  weeks  to  two  or  three  months  the  infant  should 
be  brought  back  gTadually  to  the  usual  milk  formulas. 


INDISPOSITION,    INDIGESTION,    ETC.  103 


'     .  •  INDISPOSITION,    INDIGESTION,    ETC. 

What  changes  in  the  food  are  required  hy  slight 
indisposition  f 

For  slight  general  disturbances  snch  as  dentition, 
colds,  sore  throats,  etc.,  it  is  usually  sufficient  simply 
to  dilute  the  food.  If  this  is  but  for  two  or  three 
feedings,  it  is  most  easily  done  by  replacing  with 
boiled  water  an 'ounce  or  two  of  the  food  removed 
from  the  bottle  just  before  it  is  given ;  if  for  several- 
days,  a  weaker  formula  should  be  used. 

What  changes  should  he  made  for  a  serious  acut& 
illness  ? 

For  such  attacks  as  those  of  pneumonia,  bron- 
chitis, measles,  etc.,  attended  with  fever,  the  food 
should  be  diluted  and  the  fat  reduced  as  described 
on  page  100.  "It  should  be  given  at  regiilar  intervals, 
rather  less  frequently  than  in  health.  Water  should 
be  given  freely  between  the  feedings.  Food  should 
.not  be  forced  in  the  early  days  of  an  acute  illness, 
since  the  loss  of  appetite  usually  means  an  inability 
to  digest  much  food. 

What  immediate  changes  should  he  made  in  the 
food  ivhen  the  child  has  an  acute  attach  of  gastric  in- 
digestion with  repeated  vomiiing,  fever,  pain,  etc.f 

All  milk  should  be  stopped  at  once,   and  only 


104     THE    CAEE    AND    FEEDING    OF    CHILDEEN 

boiled  water  given  for  ten  or  twelve  hours ;  after- 
ward barley-water  or  broth  may  be  tried,  but  no 
milk  for  at  least  twenty-four  hours  after  the  vom- 
iting has  ceased.  When  beginning  with  modified 
milk,  formulas  made  from  skimmed  milk  as  de- 
scribed on  page  97  should  be  used  for  a  few  days. 
Lime-water  may  be  added  to  the  food. 

What  changes  should  he  made  for  an  attach  of 
intestinal  indigestion  with  looseness  of  the  hoivels? 

If  this  is  not  severe  (only  two  or  three  passages 
daily),  the  sugar,  especially  milk  sugar,  should  be 
omitted,  and  the  milk  should  be  boiled  for  Ry&  min- 
utes. If  undigested  milk  appears  in  the  stools,  it 
may  be  diluted  with  an  equal  amount  of  barley 
water.  If  the  diarrhoeal  attack  is  more  severe,  and 
attended  by  fever  and  foul-smelling  movements  of 
greater  frequency,  all  milk  'should  be  stopped  im- 
mediately, and  the  diet  mentioned  just  above  under 
the  head  of  acute  disturbances  of  the  stomach  should 
I)e  employed. 

What  changes  in  the  food  should  he  made  when 
ihe  child  seems  to  have  very  little  appetite  and  yet 
is  not  ill? 

The  number  of  feedings  should  be  reduced,  the 
interval  being  lengthened  by  one  hour  or  even  more. 
'No  greater  mistake  can  be  made  than  to  offer  food 


THE  ADDITION  OF  OTHER  FOOD  105 

evei'v  hour  or  two  to  an  infant  who  is  not  hungry. 
That  only  prolongs  and  aggravates  the  disturbance. 

What  other  conditions  besides  the  food  greatly 
influence  the  child's  digestion? 

Proper  clothing,  warm  feet,  regular  habits,  fresh 
air,  clean  bottles,  and  food  given  at  the  proper  tem- 
perature, are  all  quite  as  important  as  the  prepara- 
tion of  the  food ;  quiet,  peaceful  surroundings  and 
absence  of  excitement  are  also  essential  to  good  di- 
gestion. In  many  cases  in  which  children  suffer  fre- 
quently from  indigestion  and  do  not  gain  properly  in 
weight,  the  fault  is  not  with  the  food  but  with  the 
care  that  the  child  receives.  Both  while  the  food  is 
being  taken  and  afterwards  he  should  be  left  quite 
alone.  This  is  particularly  necessary  with  nervous 
children. 

THE   ADDITION   OF    OTHER   FOOD 

What  food  besides  the  milk  formula^  may  be 
given  during  the  first  year? 

Fruit  juices,  broth,  beef  juice,  egg  and  crisp 
toast,  dried  bread  or  a  milk  cracker. 

When  and  how  should  fruit  juices  be  given? 
With  most  infants  they  should  be  begun  at  seven 
or  eight  months ;  some  with  advantage  can  take  them 


106      THE    CAEE    AND    FEEDING    OF    CHILDEEN 

as  early  as  five  or  six  months.  At  first  only  three  or 
four  teaspoonfuls  once  a  day  are  given ;  the  quantity 
may  be  gradually  increased  until  the  child  is  given 
one  ounce  twice  a  day.  The  best  time  is  about  mid- 
way between  the  feedings. 

What  fruit  juices  may  he  used? 

Orange  juice  is  probably  the  most  convenient. 
The  fruit  should  be  fresh  and  sweet.  The  juice  of 
fresh  peaches  or  other  ripe  fruits  may  be  used  in  the 
same  way  but  should  be  strained. 

Of  what  advantage  are  fruit  juices? 
They  help  to  keep  the  bowels  regular  and  pro- 
mote the  general  nutrition  of  the  infant. 

How  and  when  may  heef  juice  he  used? 

With  average  infants  it  may  be  begun  at  nine  or 
ten  months;  two  teaspoonfuls  may  be  given  daily, 
diluted  with  the  same  quantity  of  water,  fifteen  min- 
utes before  the  midday  feeding;  in  two  weeks  the 
quantity  may  be  doubled;  and  in  four  weeks  six 
teaspoonfuls  may  be  given.  The  maximum  quantity 
at  one  year  should  not  be  more  than  two  or  three 
tablespoonfuls. 

With  delicate  infants  who  are  pale  and  auEemic, 
beef  juice  is  more  important  and  it  may  often  be 


THE  ADDITION  OF  OTHER  FOOD  107 

wisely  begim  at  five  or  six  months  in  smaller  quan- 
tities than  those  mentioned. 

Hoiu  are  troths  to  he  used? 

Mntton  or  chicken  broth  may  be  used  much  like 
beef  juice,  two  or  three  ounces  at  one  time.  It  may 
be  given  on  alternate  days  with  beef  juice. 

Hoiu  are  eggs  to  he  used? 

Two  or  three  teaspoonfuls  of  a  soft  "coddled" 
egg  may  be  given  at  nine  or  ten  months,  the  amount 
being  gradually  increased  until  half  an  egg  is  given, 
and  at  one  year  usually  a  whole  egg.  It  should  of 
course  be  salted.  Egg  may  be  given  once  or  twice  a 
week  in  place  of  the  broth  or  beef  juice  just  men- 
tioned. 

The  yolk  of  a  hard  boiled  egg  may  also  be  grated 
fine  and  added  to  the  milk  of  a  child  as  young  as 
six  or  seven  months.  ♦ 

It  should  be  remembered  that  some  infants  are 
very  sensitive  to  eggs  and  cannot  take  them  at  all. 

Hoiu  soon  should  toast  and  crackers  he  given? 

This  depends  somewhat  on  the  number  of  teeth. 
The  average  child  can  nibble  at  a  small  piece  of  thin 
crisp  toast  when  he  is  nine  or  ten  months  old.  It 
should  be  given  at  feeding  time  and  at  first  but  once 


108      THE    CAEE    AND    FEEDING    OF    CHILDEEN 

a  day.     Later  a  larger  amount  may  be  tried.     Its 
chief  value  is  in  teaching  the  child  to  chew  his  food. 

SUBSTITUTES    FOE.    FRESH    MILK 

^Yhen  no  fresh  cow's  milh  can  he  ohtained,  what 
substitutes  are  most  reliable? 

Condensed  milk;  evaporated  milk;  sterilized 
milk  in  bottles;  dried  milk;  goat's  milk.  Of  the 
condensed  milks  available  in  the  United  States,  Bor- 
den's Eagle  brand  is  probably  the  most  reliable. 
This  contains  a  large  amount  of  cane  sugar.  Con- 
densed milk  without  any  addition  of  sugar  is  sold 
in  this  country  fresh  and  in  cans  under  the  name 
of  ^^evaporated  milk."  The  Bear  brand  of  Swiss 
condensed  milk  is  perhaps  as  trustworthy  as  any  ob- 
tained in  Europe. 

Dried  milk  is  derived  from  fresh  whole  milk  by 
rapid  evaporation  of  the  water.  Made  from  partially 
skimmed  milk,  with  the  addition  of  milk  sugar,  it 
is  sold  as  a  food  for  infants  under  the  name  of  matn- 
mala.  It  requires  only  to  be  dissolved  in  water  for 
feeding.  A  somewhat  similar  preparation  is  sold  in 
Europe  under  the  name  of  glaxo.  Sterilized  milk 
sold  in  bottles  is  widely  used  in  Europe,  but  not 
much  in  this  country.    On  the  whole,  it  is  not  so  con- 


STERILIZED,    BOILED,    PASTEURIZED    MILK     109 

venient,  and  I  think  less  reliable  than  condensed 
milk. 

The  evaporated  milk  is  to  be  preferred  in  infant 
feeding  to  the  sweetened  condensed  milk.  To  this 
any  form  and  any  amount  of  sugar  desired  may  be 
added ;  the  objections  to  the  use  of  the  large  amount 
of  cane  sugar  are  thus  avoided. 

All  of  these  substitutes  are  open  to  the  same  ob- 
jections, and  though  convenient  for  travelling  and 
often  necessary  for  use  in  foreign  countries,  they  are 
not  to  be  advised  as  permanent  infant  foods  where 
fresh  cow's  milk  can  be  obtained ;  they  are,  however, 
to  be  preferred  to  the  proprietary  infant  foods. 

Goat's  milk  may  be  had  in  many  foreign  coun- 
tries, and  when  fresh  and  produced  in  cleanly  condi- 
tions it  is  to  be  preferred  to  any  of  the  substitutes 
mentioned  above  as  a  permanent  food.  For  most  in- 
fants, it  requires  the  same  modification  as  cow's  milk. 

STERILIZED    MILK,    BOILED    MILK,    PASTEURIZED    MILK 

» 

What  is  meant  by  sterilizing  milh? 
Heating   milk    for    the    purpose    of    destroying 
germs. 

Does  all  cows'  milJc  contain  germs? 
Yes ;  even  when  handled  most  carefully,  milk  con- 
tains many  germs ;  but  when  carelessly  handled,  and 


110      THE    CAEE    AXD    FEEDING    OF    CHILDEEN 

in  summer,  tlie  number  is  enormous.  While  most  of 
these  are  harmless  or  cause  only  the  souring  of  milk, 
others  are  occasionally  present  which  may  produce 
serious  diseases,  such  as  typhoid  fever,  diphtheria, 
scarlet  fever,  septic  sore  throat,  tuberculosis,  and 
some  forms  of  diarrhoea. 

Under  what  circumstances  is  it  necessary  to  ster- 
ilize milk? 

1.  In  v^arm  v^eather,  when  it  cannot  be  obtained 
fresh;  hence  always  in  cities  and  towns  during  the 
summer. 

2.  When  one  cannot  be  certain  that  the  cows  are 
healthy,  or  that  the  milk  has  been  carefully  handled. 

3.  When  the  milk  is  to  be  kept  for  any  consider- 
able time  (i.  e.,  over  twenty-four  hours) ,  especially 
if  no  ice  can  be  had. 

4.  During  epidemics  of  typhoid  or  scarlet  fever, 
sore  throat,  or  dysentery. 

What  are  the  two  methods  of  heating  milk? 

The  first  is  known  as  sterilizing,  in  which  the 
milk  was  at  first  heated  to  212°  F.  for  one  hour  or 
one  hour  and  a  half.  Xow  it  is  usually  sterilized 
by  boiling  for  ten  minutes.  The  second  method  is 
knov^m  as  pasteurizing,  in  which  the  milk  is  heated 
to  155°  or  160°  F.  for  thirty  minutes.  A  tempera- 
ture of  155°  F.  continued  for  thirty  minutes  is  suffi- 


STERILIZED,    BOILED,    PASTEURIZED    MILK     111 

cient  to  kill  the  germs    of  the   diseases  above  re- 
ferred to. 

Will  milk  which  has  been  thus  treated  keep  in- 
definitely? 

'No',  for  although  all  the  living  germs  may  be 
killed,  there  are  many  undeveloped  germs,  or  spores, 
which  are  not  destroyed,  and  which  soon  grow  into 
living  germs.  Milk  heated  to  212°  F.  for  an  hour 
will  often  keep  upon  ice  for  two  or  three  weeks ;  that 
heated  to  155°  F.  should  be  used  within  24  hours. 

Is  milk  which  has  heen  sterilized  alivays  a  safe 
foodf 

^o;  for  the  reason  that  the  milk  may  be  so  old, 
so  dirty,  and  so  contaminated  before  sterilizing  that 
it  may  be  still  unfit  for  infant  feeding,  though  it 
contains  no  living  germs. 

Is  cow's  milk  rendered  more  digestible  by  being 
heated  in  this  way  f 

For  most  infants,  sterilizing  milk  does  not  im- 
prove its  digestibility,  but  there  are  some  who  cer- 
tainly do  better  upon  boiled  or  sterilized  milk.  If 
an  infant  is  not  doing  well  upon  raw  milk,  boiled 
milk  may  be  used.  Sterilized  milk  should  be  modi- 
fied for  infant  feeding  in  the  same  way  as  milk 
which  has  not  been  heated. 


112      THE    CAEE    AND    FEEDING    OF    CHILDEEN 

Is  milk  in  any  way  injured  hy  heating  to 
212''  FJ 

Milk  is  rendered  more  constipating,  and  for  some 
children  its  nutritive  properties  are  injured,  so  that 
it  may  cause  scurvy ;  this,  however,  is  not  likely  un- 
less it  is  continued  as  the  sole  food  for  a  long  period. 
These  objections  are  of  so  much  importance  that  this 
plan  of  heating  milk  is  not  to  be  recommended  for 
general  use.  Raw  milk  and  sterilized  milk  are  really 
different  products;  each  has  its  advantages  and  its 
drawbacks. 

When  is  it  advantageous  to  heat  milk  to  212°  F.f 
For  use  upon  long  journeys,  such  as  crossing  the 
ocean.     Milk  should  then  be  heated  for  one  hour 
upon  two  successive  days,  without  removing  the  stop- 
pers from  the  bottles. 

Is  milk  in  any  way  injured  hy  heating  at  155°  F, 
for  thirty  minutes  f 

The  unfavorable  effects,  if  there  are  any,  are 
so  slight  that  they  should  not  deter  one  from  the 
use  of  pasteurized  milk,  even  for  long  periods.  The 
preference,  however,  should  be  given  to  milk  which 
is  so  clean  and  so  fresh  as  not  to  require  any  heat- 
ing; but  only  the  cleanest  and  freshest  milk  can  be 
given  raw,  certainly  during  warm  weather. 


STERILIZED,    BOILED,    PASTEURIZED    MILK     113 

-  How  should  milk  he  sterilized  f 
'So  special  form  of  apparatus  is  required.     It 
should  be  boiled  for  ten  minutes  in  the  bottles  from 
which  it  is  to  be  fed ;  then  rapidly  cooled  and  Dlaced 
on  ice. 

How  should  milk  he  pasteurized? 

A  convenient  form  of  apparatus  is  the  Freeman 
pasteurizer  ^ ;  another  is  the  Walker-Gordon  pas- 
teurizer.^    Other  good  ones  are  sold  in  the  stores. 

How  should  milk  he  cooled  after  pasteurizing? 

Always  by  placing  the  bottles  in  cold  water,  so  as 
to  cool  them  rapidly ;  never  by  letting  them  stand  at 
the  temperature  of  the  room,  or  by  placing  them, 
when  warm,  in  an  ice  box. 

Why  is  this  precaution  necessary  f 

Cooling  in  the  air  or  in  an  ice  box  requires  from 
two  to  four  hours,  and  during  that  time  a  great  many 
of  the  undeveloped  germs  may  mature  and  greatly 
injure  the  keeping  properties  of  the  milk.  In  the 
cold  water  milk  can  be  cooled  in  from  ten  to  twenty 
minutes  if  the  water  is  frequently  changed,  or  if  ice 
is  added  to  the  water.  ^ 

1  This  can  be  obtained  at  411  West  Fifty-ninth  Street,  New 
York,  with  bottles  and  full  directions;  a  tin  one,  at  a  cost  of 
$3.50,  and  a  copper  one,  which  is  much  more  durable,  for  $7.00. 

2  Obtained  at  the  same  prices  from  any  of  the  Walker-Gordon 
milk  laboratories. 

8 


114      THE    CAEE    AND    FEEDING    OF    CHILDREN 

Is  it  better  to  rely  upon  the  pasteurization  of 
milk  at  home,  or  to  purchase  that  which  has  been 
jpasteurized  before  delivery  f 

The  Lome  pasteurization  is  by  all  means  to  be 
preferred.  Considerable  danger  may  lurk  in  com- 
mercially pasteurized  milk  because  of  the  false  sense 
•of  security.  For  safety,  several  things  are  necessary : 
The  milk  should  be  reasonably  clean  before  pasteur- 
ization ;  the  apparatus,  the  bottles,  or  other  utensils 
-containing  milk  should  be  carefully  sterilized,  and 
the  whole  process  carried  on  with  the  most  scrupulous 
•care  and  cleanliness.  Since  pasteurization  kills 
■chiefly  the  bacteria  which  cause  milk  to  sour,  other 
^erms,  the  spores  of  which  are  not  killed  by  such 
Jieating,  may  develop  rapidly  unless  the  milk  is  kept 
•cold,  and  though  it  may  not  turn  sour,  it  may  contain 
immense  numbers  of  germs  when  it  is  delivered  or 
used.  It  should  be  kept  carefully  iced,  and  used 
within  twenty-four  hours  after  heating. 

MODIFIED    MILK    OF    THE   MILK    LABOEATOEIES 

What  is  ''modified  miW  of  the  m,ilk  labora- 
tories f 

It  is  milk  containing  definite  proportions  of  the 
fat,  sugar,  protein,  etc.,  put  up  usually  according 
to  the  prescription  of  a  physician,  who  indicates  how 


FROZEN    MILK  115 

much  of  the  different  elements  he  desires.  The  most 
reTiahle  are  the  laboratories  of  the  Walker-Gordon 
Company,  which  has  branches  in  most  of  the  large 
cities  of  the  United  States. 

This  is  an  excellent  method  of  having  milk  pre- 
pared, since  it  can  be  done  with  greater  care  and 
cleanliness  than  are  possible  in  most  homes.  It  is, 
besides,  a  great  convenience,  if  circumstances  make 
it  impossible  to  prepare  the  milk  properly  at  home. 

The  laboratory  should  be  used  for  infant  feed- 
ing only  by  one  who  is  somewhat  familiar  with  this, 
method  of  ordering  milk. 


FROZEN    MILK 

Is  milk  in  any  way  injured  for  infant  feeding  hy 
having  been  frozen? 

Only  the  water  of  the  milk  freezes.  The  forma- 
tion of  a  little  ice  in  the  milk  is  of  no  importance: 
but  when  milk  which  has  been  frozen  almost  solid 
is  thawed  and  later  heated  for  use,  a  separation  of 
the  fat  sometimes  takes  place  so  that  it  appears  like 
oil  at  the  top  of  the  bottle.  Healthy  infants  are 
not  affected  by  such  milk;  but  very  delicate  infants 
are  sometimes  upset  by  it,  and  acute  diarrhoea  may 
even  be  excited.     During  the  few  days  of  such  ex- 


116   THE  CAKE  AND  FEEDING  OF  CHILDREN 

tremely  cold  weather  that  it  is  impossible  to  trans- 
port milk  without  its  freezing,  condensed  milk  may- 
be substituted  for  such  infants. 

PEPTONIZED   MILK 

What  is  peptonized  milk  f 

Milk  in  which  the  protein  (curd)  has  been  par- 
tially digested. 

How  is  this  accomplished? 

By  the  action  of  a  peptonizing  powder  which  is 
composed  of  a  digestive  agent  known  as  the  extractum 
pancreatis  and  bicarbonate  of  soda,  which  is  added 
to  the  plain  or  diluted  milk.  This  is  sold  in  tubes 
or  in  tablets,  and  it  is  the  active  ingredient  of  the 
peptogenic  milk  powder. 

Since  it  is  infrequent  for  the  protein  of  milk  to 
l>e  the  cause  of  indigestion,  peptonizing  milk  has  a 
very  limited  use,  chiefly  in  cases  of  acute  illness. 

CONDENSED    MILS 

What  is  condensed  milJcf 

Fresh  milk  which  has  been  sterilized  and  then 
some  of  the  water  evaporated  until  one  part  repre- 
sents about  two  and  a  half  parts  of  the  original  milk. 


CONDENSED    MILK  117 

The  sweetened  condensed  milk  usually  has  cane  sugar 
added  in  the  proportion  of  about  seven  ounces  to  one 
pint. 

Condensed  milk  is  also  sold  fresh  and  in  cans 
without  any  addition  of  cane  sugar.  To  distinguish 
it  from  the  usual  variety,  this  is  sometimes  called 
simply  '^evaporated"  milk.  The  Peerless  brand  i& 
perhaps  the  most  reliable.  It  is  about  the  same 
strength  and  requires  the  same  dilution  as  the  usual 
condensed  milk. 

How  should  condensed  milk  he  used? 

For  an  infant  three  or  four  months  old  with 
symptoms  of  indigestion,  it  should  at  first  be  diluted 
wdth  12  parts  of  boiled  water,  or,  sometimes  prefer- 
ably, with  barley-water.  With  improvement  in  the 
symptoms,  the  dilution  may  be  1  to  11,  1  to  10,  and 
1  to  8,  etc.,  these  changes  being  gradually  made.  The 
intervals  between  feedings  and  the  quantities  for  one 
feeding  are  given  on  page  Y7. 

The  "evaporated"  milk  requires  the  same  addi- 
tion of  carbohydrates  (sugar  and  starch)  as  does  plain 
milk.  The  total  amount  of  sugar  added  should  be 
about  one  ounce  to  twenty  ounces  of  the  food  pre- 
pared. The  sugar  may  be  milk  sugar,  maltose  or 
cane  sugar,  often  advantageously  some  of  each.  The 
starch  may  be  given  in  the  form  of  barley,  wheat,  or 


118      THE    CAEE    AND    FEEDING    OF    CHILDEEN 

oat  gruel,  not  more  than  eight  or  ten  ounces  in  the 
•daily  food. 

75  condensed  milk  or  '' evaporated''  milk  more 
■easily  digested  than  modified  plain  milk  or  pasteur- 
ized milk? 

By  some  especially  delicate  infants  it  appears  to 
be,  and  may  be  tried  where  other  forms  of  milk  do 
not  agree. 

How  long  should  condensed  milk  he  continued? 

In  most  cases  it  should  be  used  as  the  sole  food 
for  a  month  or  two  only.  Afterward,  one  feeding  a 
day  of  a  weak  formula  of  modified  milk  (e.  g.,  ISTo.  II 
or  III  While  Milk  Series,  page  Y3)  may  be  given; 
later  two  feedings,  and  thus  gradually  the  number  of 
modified  milk  feedings  is  increased  until  the  child  is 
taking  only  modified  milk. 

Condensed  milk  is  not  to  be  recommended  as  a 
permanent  food  where  good  fresh  cow's  milk  can  be 
obtained. 

Children  reared  upon  it  often  gain  rapidly  in 
weight,  yet  have  as  a  rule  but  little  resistance.  They 
are  very  prone  to  develop  rickets,  and  sometimes 
.scurvy. 


PEOTEIN  MILK  OE  CASEIN  MILK        119- 


',  BUTTERMILK 

What  are  the  advantages  of  huttermilh  in  infant 
feeding? 

Chiefly  that  the  fat  has  been  removed,  this  ele- 
ment being  the  one  with  which  many  children  have- 
difficulty;  there  are,  besides,  some  changes  in  the 
sugar  and  protein,  due  to  the  slight  fermentation. 
which  takes  place  in  the  souring  of  the  milk. 

When  is  huttermilk  to  he  employed? 
It  is  useful  in  many  cases  of  severe  chronic  indi- 
gestion and  in  some  cases  of  acute  indigestion. 

How  is  it  prepared  and  fed? 

Fresh  buttermilk  may  be  purchased  at  many 
dairies  ;  or  sterilized  skimmed  milk  may  be  fermented, 
by  various  ferments  sold  in  tablet  form,  such  as  ^'lac- 
tone," ^'bulgara,"  etc. ;  or  a  specially  prepared  butter- 
milk may  be  purchased  from  one  of  the  milk  labora- 
tories known  as  ^'lactic  acid  milk,"  or  elsewhere  under- 
a  great  variety  of  other  names.  It  may  be  fed  as. 
prepared,  or  diluted  with  water  or  barley  gruel. 

PROTEIN  MILK  OR  CASEIN  MILK 

What  is  ''caseiri^  milk? 

This  term  has  been  given  to  a  form  of  modified 


120      THE    CAEE    AND    FEEDING    OF    CHILDREN 

milk  known  in  Germany  as  "eiweiss  milcti/'  in  which 
much  of  the  milk  sugar  has  been  removed  and  the 
casein  increased. 

When  is  this  useful? 

Chiefly  in  cases  of  indigestion,  acute  or  chronic, 
accompanied  by  diarrhoea. 

~    ^ 

Hoiv  is  casein  milk  ^prepared? 

One  quart  of  whole  milk  warmed  to  blood  heat  is 
coagulated  by  rennet  (see  page  152),  the  whey  is 
then  strained  off  through  cheese  cloth  and  thrown 
away.  The  dry  curd  is  carefully  rubbed  through  a 
fine  wire  sieve  with  the  gradual  addition  of  one 
pint  of  buttermilk.  Enough  water  is  then  added  to 
bring  the  whole  up  to  one  quart. 

How  is  it  fed? 

For  older  infants  it  is  given  as  prepared  above; 
for  younger  and  more  delicate  ones  it  is  at  first  di- 
luted with  one  fourth  its  volume  of  water.  It  may  be 
continued  for  one  or  two  weeks,  or  until  the  symp- 
toms improve;  then  maltose  or  cane  sugar  is  slowly 
added.  Later  the  infant  is  given  formulas  from 
whole  milk  (page  73). 


FEEDING    DURING    THE    SECOND    YEAR         121 


FEEDING  DUEmG  THE  SECOE'D  YEAR 

If  the  general  directions  given  in  previous  pages 
have  been  foliov^^ed,  the  infant  will  be  taking  at  eleven 
or  twelve  months  five  meals,  at  four-hour  intervals, 
8  or  9  ounces  at  a  time.  Of  this,  about  three-fourths 
should  be  milk  and  one-third  gruel — i.  e.,  Formula 
XIV,  page  74.  Besides  this,  he  will  probably  be 
receiving  orange  juice,  one  or  two  ounces  a  day,  and 
beef  juice,  one  ounce  a  day. 

How  many  meals  are  required  in  the  second  year? 

Usually  five  meals.  Some  children  will  sleep 
from  6  p.  M.  to  6  a.  m.  without  waking,  but  unless 
there  is  a  feeding  at  10  p.  m.  most  children  are  apt  to 
wake  very  early  in  the  morning. 

Should  each  feeding  he  prepared  at  the  time 
given,  or  all  feedings  at  one  time,  as  during  the  first 
year? 

During  the  second  and  third  years  it  is  better  to 
prepare  the  milk  for  the  entire  day  at  one  time. 

When  only  plain  milk  is  used,  the  quantities 
needed  for  the  different  feedings  should  be  put  into 
separate  bottles,  which  then  may  be  pasteurized  or 
not  as  is  necessary.  In  this  way  the  difi^erent  feed- 
ings are  kept  separate,  and  the  day's  supply  of  milk 


122      THE    CARE    AND    FEEDING    OF   CHILDREN 

is  not  disturbed  every  time  the  child  is  fed,  as  other- 
wise is  unavoidable.  The  food  should  be  prepared  as 
soon  as  possible  after  the  daily  milk  supply  is  deliv- 
ered in  the  morning. 

What  changes  may  now  he  made  in  the  food? 

The  proportion  of  milk  in  the  food  may  be  in- 
creased ;  the  milk  sugar  may  be  omitted ;  broth  may 
be  added  to  one  of  the  feedings.  The  child  should 
begin  to  take  at  least  part  of  his  food  from  the  cup. 

Give  a  proper  diet  for  an  average  healthy  child  of 
twelve  months. 

6.30  A.  M.     Milk,  six  to  seven  ounces;  diluted  with  barley  or  oat 
gruel,  two  to  three  ounces;  after  the  thirteenth 
month,  taken  from  a  cup. 
9  A.  M.     Orange  juice,  one  to  two  ounces. 
10  A.  M.     Milk,  two  parts;  oatmeal  or  barley  gruel,  one  part; 
from  ten  to  twelve  ounces  in  all  may  be  al- 
lowed; it  should  be  given  from  a  cup. 
2  P.  M.     Beef  juice,  one  to  two  ounces; 

or,  the  white  of  one  egg,  shghtly  cooked;  later 
the  entire  egg; 

or,  mutton  or  chicken  broth,  four  to  six  ounces. 
Milk  and  gruel  in  proportions  above  given,  four  to 
six  ounces. 
6  p.  M.     Same  as  at  10  a.  m. 

10  p.  M.     Same  as  at  6.30  a.  m.,  except  that  the  food  may  be 
given  from  the  bottle. 

How  long  may  this  schedule  he  followed? 

Usually  until  the  fourteenth  or  fifteenth  month. 
After  this  time  the  cereals  may  be  given  much  thicker 
and  fed  from  a  spoon. 


FEEDING    DUEING    THE    SECOND    YEAR         123 

'     May   any    other  fruit  juices   he   given   at    this 
period  ? 

Orange  juice  is  the  best ;  next  to  this,  the  juice  of 
fresh  ripe  peaches,  red  raspberries,  or  strawberries. 
All  these  should  be  strained  very  carefully  through 
muslin  to  make  sure  that  the  child  gets  none  of  the 
pulp  or  seeds,  either  of  which  may  cause  serious  dis- 
turbance. Of  the  orange  or  peach  juice,  from  one  to 
four  tablespoonfuls  may  be  allowed  at  one  time;  of 
the  others  about  half  the  quantity.  The  fruit  juice  is 
best  given  one  hour  before  the  second  feeding. 

When  should  a  child  he  iveaned  from  its  hottlef 
Most  children  can  and  should  be  taught  to  take 
their  food  from  the  cup  or  spoon  before  they  are  thir- 
teen months  old ;  but  it  is  convenient  to  give  the  10 
p.  M.  feeding  from  the  bottle  as  long  as  this  feeding 
is  continued. 

Give  a  proper  diet  for  an  average  child  from  the 
fourteenth  to  the  eighteenth  month. 

The  bottle  should  not  be  given  except  possibly  at 
night.  Cereals  may  now  form  an  important  part  of 
the  diet.  They  should  be  very  thoroughly  cooked, 
usually  for  three  hours,  but  not  strained. 

The  daily  schedule  should  be  about  as  follows : 


124      THE    CAEE    AND    FEEDING    OF    CHILDEEN 


6.30  to  7  A.  M.     Warm  milk,  eight  to  nine  ounces,  given  from  a 
cup 
9  A.  M.     Fruit  juice,  one  to  three  ounces. 
10  to  10.30  A.  M.     Cereal:  two  good  tablespoonfuls  of  thick  por- 
ridge of  oatmeal,  hominy  or  wheaten  grits, 
cooked  for  at  least  three  hours  and  not 
strained;    upon    this    one    ounce    of    thin 
cream  or  two  ounces  of  milk,  plenty  of 
salt,  no  sugar. 
Crisp  dry  toast  or  unsweetened  zwieback  or 

dried  bread,  one  piece. 
Warm  milk,  five  to  six  ounces. 
2  P.  M.     Beef   juice,    two   ounces;  <and   one   egg    (soft 
boiled,  poached  or  coddled) ;  and  one  small, 
mealy,  baked  potato; 
or,  broth  (mutton  or  chicken),  four  ounces; 
and  (if  most  of  the  teeth  are  present)  rare 
scraped    beef,    at    first    one    teaspoonful, 
gradually   increasing  to   one   level   table- 
spoonful;  boiled  rice  (cooked  five  hours), 
one  or  two  good  tablespoonfuls. 
Crisp  dried  bread,  one  piece. 
No  milk. 
6  P.  M.     Cereal :  two  or  three  good  tablespoonfuls  of 
farina  or  cream  of  wheat;  cooked  for  at 
least  one  hour;  served  as  at  the  10  a.  m. 
feeding. 
Warm  milk,  five  to  six  ounces. 
10  P.  M.     Warm  milk,  six  to  eight  ounces. 


Give  a  proper  diet  for  an  average  child  from  the 
eighteenth  month  to  the  end  of  the  second  year. 

The  same  order  of  meals  as  for  the  months  just 
preceding  should  be  followed.  For  a  few  children,  a 
milk  feeding  at  10  p.  ^r.  is  desirable ;  bnt  m^ost  chil- 
dren can  readily  bo  trained  to  go  from  6  p.  m.  to  6.30 
A.  M.  without  food,  and  will  sleep  better  than  when 
fed  at  ten  o'clock. 


FEEDING    DURING    THE    SECOND    YEAR         125 


-The  daily  schedule  should  be  about  as  follows : 

6.30  to  7  A.  M.     Warm  milk,  eight  to  ten  ounces,  given  from  a 
cup. 
9  A.  M.     Fruit  juice,  two  to  three  ounces. 
10  to  10.30  A.  M.    Cereal,   of  those  recommended  for  the  four- 
teenth to  the  eighteenth  month,  three  good 
tablespoonf uls ;  cooked  and  served  as  de- 
scribed in  the  previous  diet. 
Crisp  dried  bread,  zwieback  or  Huntley  and 

Palmer  breakfast  biscuits. 
Warm  milk,  one  cup  (six  ounces).  ^ 

2  P.  M.     Beef  juice,  two  ounces,  and  one  soft  egg; 

or,  broth,  four  ounces,  and  meat,  one  level 
tablespoonf ul;  care  being  taken  that  the 
meat  is  always  rare  and  scraped  or  very 
finely  divided;  beefsteak,  lamb  chop  or 
roast  beef  may  be  given. 
Small,  thoroughly  baked  potato;  or  rice,  two 

tablespoonf  uls. 
Stewed  carrots  or  fresh  green  peas,  strained, 

one  level  tablespoonful. 
Prune  pulp  or  baked  apple,  one  to  two  table- 
spoonfuls. 
Water.     (No  milk.) 
6  P.  M.     Cereal:  three  tablespoonf  uls  of  farina  or  cream 
of  wheat,  cooked  for  at  least  one  hour; 
served  as  described  in  previous  diets;  and 
warm  milk,  eight  ounces; 
or,  bread  and  milk  (stale  bread,  three  days 
old,  two  sUces,  and  ten  to  twelve  ounces  of 
warm  milk). 

Instead  of  the  hours  mentioned  for  the  different  meals  in 
this  diet  and  the  preceding  one,  it  is  sometimes  more  convenient 
to  give  the  fruit  juice  at  6.30  a.  m.  or  on  waking,  cereal,  etc.,  at 
7.30  and  the  milk  at  10.30.  With  most  children  this  arrangement 
answers  quite  as  well. 

What  fruits  may  he  given  at  this  period? 

If  the  child  has  a  feeble  digestion,  only  the  fruit 


126      THE    CAEE    AND    FEEDING    OF    CHILDREN 

juices  previously  allowed ;  strong  children  may  have 
in  addition  prune  pulp,  baked  apple,  and  apple-sauce. 
The  prune  pulp  is  prepared  by  stewing  the  dried 
prunes  without  sugar  until  they  are  very  soft,  and  re- 
moving all  the  skin  by  putting  the  fruit  through  a 
strainer ;  of  this  from  one  to  two  tablespoonfuls  may 
be  given  at  one  time.  The  baked  apple  should  be 
given  without  cream,  and  the  apple-sauce  should  have 
very  little  sugar.  ^ 

How  and  when  should  water  he  given? 

Throughout  the  second  year  water  should  be 
given  freely  between  the  feedings,  especially  in  warm 
weather;  from  one  to  three  ounces  may  be  given  at 
one  time,  either  from  a  spoon,  a  glass,  or  a  bottle. 
The  water  should  be  boiled  daily  and  then  cooled.  It 
should  not  be  allowed  to  stand  in  the  room,  but  fresh 
water  should  be  put  into  the  bottle  each  time. 

rEEDiiSTG  duei:ng  the  THIED  YEAE 

What  changes  may  he  made  in  the  diet  during  the 
third  year? 

Three  regular  meals  should  be  given  and  milk 
once  besides,  either  between  the  breakfast  and  dinner 
or  dinner  and  supper,  whichever  is  the  longer  inter- 
val.   Water  should  be  allowed  freely  between  meals. 


FEEDING    DURING    THE    THIRD    YEAR  127 

'What  would  he  a  proper  schedule  for  an  average 
child  during  the  third  year? 

7.30  A.  M.    Cereal:  three  good  tablespoonfuls;  cooked  prefer- 
ably overnight  or  for  three  hours;  a  somewhat 
larger  variety  may  be  given  than  during  the 
second  year;  served  as  described  in  the  previous 
diets;  the  addition  of  one-half  teaspoonful  of 
sugar  may  be  permitted. 
Warm  milk,  one  cup  (six  ounces). 
A  soft  egg,  poached,  boiled  or  coddled. 
Bread  (very  stale  or  dried),  one  shce,  with  butter. 
10.30  A.  M.     Warm   milk,   one  cup    (six  ounces),  with   a   milk 
cracker  or  piece  of  very  stale  bread  with  butter. 
2  p.  M.     Clear  broth  or  soup  (mutton  or  chicken  in  which 
rice  or  barley  has  been  cooked  and  strained 
out),  four  ounces. 
Meat,  two  level  tablespoonfuls:  lamb  chop,  beef- 
steak, roast  beef  or  lamb  or  chicken. 
A  thoroughly  baked  white  potato; 

or,  boiled  rice  (cooked  five  hours). 
Green  vegetable,  one  level  tablespoonful:  asparagus 
tips,  string  beans,  peas,  spinach,  carrots;  all 
to  be  cooked  until  very  soft,  and  mashed,  or 
preferably  put  through  a  sieve. 
Dessert:  cooked  fruit — baked  or  stewed  apple  or 
four  or  five  soft  stewed  prunes  (skins  removed). 
Water.     (No  milk.) 
6  P.  M.     Cereal:  three  good  tablespoonfuls  of  farina,  corn 
meal  or  cream  of  wheat,  cooked  for  at  least 
one  hour;  served  as  in  the  morning  meal;  and 
one  glass  of  milk; 
or,  bread  and  milk; 

or,  stale  or  dried  bread  with  butter  and  a  glass  of 
milk. 


PART  III 
THE  DIET  OF  OLDER  CHILDREN 


Ill 

THE  DIET  OF  OLDER  CHILDREN 

(fourth  to  tenth  year) 

Throughout  this  period  the  largest  meal  should 
always  be  in  the  middle  of  the  day,  and  a  light  sup* 
per  given,  very  much  like  that  described  for  the  third, 
year.  During  the  first  half  of  this  period,  milk  may^ 
be  allowed  once  either  between  breakfast  and  dinner 
or  dinner  and  supper ;  no  other  eating  between  meals, 
should  be  permitted,  but  water  should  be  allowed 
freely. 

MILK    AND    CREAM 

What  part  of  the  diet  should  milk  form  during- 
childhood  f 

It  should  form  a  very  important  part;  nothing 
can  take  its  place.  There  are  comparatively  few 
children  who  cannot  take  and  digest  milk  if  it  is. 
properly  fed. 

Why  is  milk  so  advantageous^ 

Because  no  food  that  we  possess  has  so  high  a. 

131 


132      THE    CAEE    AND    FEEDING    OF    CHILDEEN 

oiutritive  value  as  milk,  for  the  amount  of  work  re- 
quired of  the  organs  of  digestion.  It  is,  therefore, 
peculiarly  adapted  to  the  diet  of  the  child. 

What  are  the  essential  joints  in  the  use  of  milk? 

It  should  be  clean  and  fresh,  but  not  too  rich.  It 
is  a  mistake  to  select  for  any  children  the  rich  milk  of 
.a  Jersey  herd  and  use  it  as  though  it  were  an  ordi- 
nary milk,  ^or  should  a  child  be  permitted  to  eat  a 
hearty  meal  of  solid  food  and  then  drink  one  or  two 
glasses  of  milk  as  if  it  were  water.  For  children 
"who  have  difficulty  in  digesting  milk,  it  should  be 
partially  skimmed,  or  diluted,  i.  e.,  one  part  of  water 
to  four  parts  of  milk,  or  salt  or  bicarbonate  of  soda 
should  be  added.  It  is  also  desirable  not  to  give  milk 
at  meals  when  fruits,  especially  raw,  sour  fruits,  are 
allowed. 

How  much  milh  may  advantageously  he  given? 

The  average  child  with  good  digestion  should  take 
two  or  three  glasses  of  milk  daily,  this  including 
only  what  the  child  drinks  but  not  what  is  served 
upon  cereals  and  in  other  ways.  It  is  seldom  wise  to 
..allow  a  child  to  take  as  much  as  one  and  a  half  or 
two  quarts  daily;  a  more  varied  diet  is  better. 

To  what  extent  may  cream  he  used? 

Older  children  do  not  require  so  large  a  propor- 


THE    DIFT    OF    OLDER    CHILDREN  133- 

tiph  of  fat  in  their  food  as  do  infants,  and  the  use  of 
mnch  cream,  especially  rich  cream,  often  results  in 
disturbances  of  digestion.  It  is  a  common  cause  of 
the  coated  tongue,  foul  breath  and  pale  gray  stools, 
often  called  ^^biliousness."  Too  much  milk,  espe- 
cially if  it  is  rich  milk,  may  produce  the  same  result. 
Of  thin  jream  or  top-milk,  not  more  than  twa 
ounces  twice  a  day  should  be  given.  Cream  should 
not  be  used  upon  fruits,  particularly  sour  fruits. 

EGGS 

To  ivliat  extent  may  eggs  he  used  in  the  diet  of 
this  period? 

They  form  a  most  valuable  food.  It  is  important 
that  they  should  be  fresh,  and  only  slightly  cooked,, 
soft  boiled,  poached,  or  coddled;  fried  eggs  should 
not  be  given,  and  most  omelets  are  objectionable. 

The  finely  grated  yolk  of  a  hard-boiled  egg  may 
be  given  with  advantage  to  many  infants  even  as- 
young  as  ^\Q  or  six  months. 

Is  it  not  true  that  eggs  often  cause  ' 'biliousness' '  f 
Very  seldom,  if  fed  as  above  advised.     This  is  an 
old  prejudice,  but  has  little  basis  in  fact. 

How  often  may  eggs  he  give,nf 
Most  children  from  four  to  ten  years  old  will  take 
one  egg  for  breakfast  and  another  for  supper  for  aui 


134      THE    CAEE    AND    FEEDING    OF    CHILDEEN 

indefinite  period  with  relish  and  benefit.  There  are, 
liowever,  some  few  who  have  a  peculiar  idiosyncrasy 
as  regards  eggs,  and  cannot  take  them  at  all. 

MEAT    AKD    FISH 

Wliat  meats  may  he  given  to  young  children? 

The  best  are  beefsteak,  larmb  chop,  roast  beef, 
Toast  lamb,  chicken,  turkey,  and  certain  delicate  fish, 
such  as  shad,  trout,  or  bass ;  to  those  of  five  or  six 
years  a  small  quantity  of  breakfast  bacon  may  be 
allowed. 

What  are  the  important  points  to  he  considered  in 
giving  meat  to  children? 

Most  meats  should  be  rare,  and  either  scraped  or 
Tery  finely  divided,  as  no  child  can  be  trusted  to  chew 
meat  properly.  Meats  are  best  broiled  or  roasted, 
l>ut  should  not  be  fried. 

Cold  meats  require  much  chewing,  and  should  not 
1)6  allowed  young  children. 

How  often  should  meat  he  given? 
At  this  period,  only  once  a  day,  at  the  mid-day 
TQeal. 

Is  not  the  excessive  nervousness  of  many  modem 
children  due  to  the  giving  of  meat,  or  at  least  aggra- 
vated hy  its  use? 

There  is  little  gTound  for  such  a  belief,  unless 


THE    DIET    OF    OLDEE    CHILDEEN  135 

an.  excessive  amount  of  meat  is  given.  Certainly 
cutting  off  meat  from  the  diet  of  nervous  children 
seldom  produces  any  striking  effect. 

What  meats  should  he  forbidden  to  young  chil- 
dren f 

Ham,  sausage,  pork,  liver,  kidney,  game,  and  all 
dried  and  salted  meats ;  also  cod,  mackerel  and  hali- 
but ;  all  of  these  are  best  withheld  until  the  child  has 
passed  the  tenth  year. 

Are  not  gravies  beneficial  and  nutritious? 

The  beef  juice,  or  so-called  "platter  gravy,''  from 
a  roast  is  exceedingly  nutritious  and  desirable,  but 
many  of  the  thickened  gTavies  are  much  less  diges- 
tible and  are  too  often  given  in  excess ;  only  a  small 
quantity  should  be  allowed.  They  should  not  form 
an  important  part  of  the  meal. 

VEGETABLES 

What  vegetables  may  be  used  at  this  period? 

White  potatoes  may  be  given  first.  These  should 
be  thoroughly  cooked  and  mealy,  preferably  baked  or 
boiled  and  mashed,  but  not  fried. 

Of  the  green  vegetables,  the  best  are  peas,  spin- 
ach, asparagus  tips,  string  beans,  young  lima  beans 
well  mashed,  stewed  celery,  young  beets,  or  carrots,. 


136      THE    CAEE    AND    FEEDING    OF    CHILDEEN 

and  squash.  Baked  sweet  potato,  turnips,  boiled 
onions,  and  cauliflower,  all  well  cooked,  may  be  given 
after  the  sixth  or  seventh  year  in  moderate  amount. 
The  principal  trouble  in  the  digestion  of  veg- 
etables is  due  to  imperfect  cooking.  It  is,  in  fact, 
almost  impossible  to  cook  them  too  much ;  they 
should  also  be  very  finely  mashed.  They  form  a 
valuable  addition  to  the  diet  after  two  years,  al- 
though the  amount  at  first  given  should  be  small — 
two  or  three  teaspoonfuls.  They  greatly  aid  in  se- 
curing regularity  of  the  bowels.  Because  small  par- 
ticles are  seen  in  the  stools,  it  is  not  to  be  inferred 
that  they  are  causing  disturbance  and  should,  there- 
fore, be  stopped,  but  only  that  they  should  be  more 
thoroughly  cooked  and  more  finely  divided  before 
being  given. 

Is  it  safe  to  use  canned  vegetables  for  cliildren? 

Many  of  the  best  brands  of  canned  vegetables  are 
quite  safe,  and  some,  such  as  peas  and  asparagus, 
<;an  be  used  with  advantage.  They  are  frequently 
better  than  stale  green  vegetables  often  sold  in  the 
markets. 

What  vegetables  should  not  he  given  to  young 
children  ? 

'None  of  those  which  are  eaten  raw,  such  as 
celery,  radishes,  onions,  cucumbers,  tomatoes,  ox  let- 


THE    DIET    OF    OLDER    CHILDEEN  137 

tuce.  Certain  others,  even  when  well  cooked,  should 
not  be  allowed ;  as  corn,  old  beets  or  lima  beans,  cab- 
bage, egg  plant.  E^one  of  these  should  be  given  until 
a  child  has  passed  the  age  of  ten  years. 

Are  vegetable  salads  to  he  given? 

As  a  rule,  salads  of  all  kinds  should  be  omitted 
until  a  child  has  passed  the  tenth  year.  Salads  are 
somewhat  difficult  to  digest,  and  unless  thoroughly 
chewed  may  be  a  cause  of  much  disturbance. 


CEREALS, 

What  are  the  most  important  points  in  selecting 
and  preparing  cereals? 

The  important  things  are  that  they  are  properly 
cooked  and  not  used  in  excess.  The  dry  or  ready-to- 
serve  cereals  should  not  be  chosen  for  children,  nor 
should  a  child,  because  he  is  fond  of  cereals,  be  al- 
lowed to  make  his  entire  meal  of  them,  taking  two 
large  saucerfuls  at  a  meal;  one  is  enough. 

For  constipated  children  the  coarse  cereals  should 
be  chosen. 

Many  of  the  partially  cooked  preparations  of 
oatmeal  and  wheat  are  excellent,  but  should  be  cooked 
for  a  much  longer  time  than  is  stated  upon  the  pack- 
age, usually  for  at  least  two  hours.     Most  of  the 


138      THE    CARE    AND    FEEDING    OF    CHILDEEN 

grains — oatmeal,  liominy,  rice,  wheaten  grits — ^re- 
quire at  least  three  hours'  cooking  in  a  double  boiler 
in  order  to  be  easily  digested.  Corn  meal,  cream  of 
wheat,  and  farina  should  be  cooked  at  least  one  hour. 
The  ^^fireless  cooker"  is  a  very  useful  contrivance  for 
cooking  cereals.  ]^one  of  the  ready-to-serve  cereals 
are  to  be  recommended  for  children. 

How  are  cereals  to  hs  given? 

Usually  with  milk  or  thin  cream;  always  with 
plenty  of  salt,  and  with  very  little  sugar — not  over 
one-half  teaspoonful  on  a  saucerful  of  cereal. 

Cereals  should  not  be  served  with  sirups  or  but- 
ter and  sugar. 

BROTHS    A:N"D    soups 

WJiat  troths  and  soups  are  to  he  recommended? 

Meat  broths  are  generally  to  be  preferred  to 
vegetable  broths — ^mutton,  beef,  or  chicken  being 
usually  most  liked  by  children.  Nearly  all  plain 
broths  may  be  given.  Those  thickened  with  rice,  bar- 
ley, or  corn  starch  form  a  useful  variety,  especially 
with  the  addition  of  milk. 

Vegetable  purees  of  peas,  spinach,  potato,  celery, 
or  asparagus  may  be  used  for  children  over  seven 
years  old.  Tomato  soup  should  not  be  given  to  young 
children. 


THE    DIET    OF    OLDER    CHILDREN  139 

BEEAD^    CEACKEES^    AND    CAKES 

What  forms  of  breadstuff s  are  best  suited  to 
young  children? 

Fresh  bread  should  never  be  given,  but  stale 
bread  cut  thin  and  freshly  dried  in  the  oven  until  it 
is  crisp  is  very  useful;  also  zwieback,  the  u.nsweet- 
ened  being  preferred.  Very  stale  bread,  three  days 
old,  may  be  given  without  drying.  Oatmeal,  gluten 
crackers,  and  the  Huntley  and  Palmer  breakfast  bis- 
cuits, stale  rolls  or  corn  bread  which  have  been  split 
and  toasted  or  dried  till  crisp,  form  a  sufficient  vari- 
ety for  most  children;  sweet  crackers  should  be 
avoided.  • 

What  breadstuff s  should  be  forbidden? 

All  hot  breads,  fresh  rolls,  buckwheat  and  other 
griddle  cakes,  all  fresh  sweet  cake,  especially  if  cov- 
ered with  icing  and  containing  dried  fruits.  A  stale 
lady-finger  or  piece  of  sponge  cake  is  about  as  far  in 
the  matter  of  cakes  as  it  is  wise  to  go  with  children 
up  to  seven  or  eight  years  old. 

DESSEETS 

What  desserts  may  be  given  to  young  children? 
Mistakes  are  more  often  made  here  than  in  any 
other  part  of  the  child's  diet.     Up  to  six  or  seven 


140      THE    CAEE    AND    FEEDING    OF    CHILDEEN 

years,  only  junket,  plain  rice,  cornstarcli,  or  farina 
pudding  witliont  raisins,  baked  custard  and,  not  more 
than  once  a  week,  a  moderate  amount  of  ice  cream. 

What  should  he  especially  forbidden? 

All  pies,  tarts,  and  pastry  of  every  description, 
jam,  sirups,  and  preserved  fruits;  nuts,  candy,  and 
dried  fruits. 

Does  ''a  little"  do  awfharmf 

Yes,  in  that  it  develops  a  taste  for  this  sort  of 
food,  after  which  plainer  food  is  taken  with  less  rel- 
ish. Besides,  the  ^^little"  is  very  apt  soon  to  become 
a  good  deal. 

Does  not  the  child's  instinctive  craving  for  sweeis 
indicate  his  need  of  them? 

That  a  child  likes  or  craves  sweets  is  the  usual 
excuse  of  an  indulgent  parent.  Every  child  likes  his 
own  way,  but  that  is  no  reason  why  he  should  not  be 
trained  to  obedience  and  self-control ;  a  child's  fond- 
ness for  sweets  can  hardly  be  considered  a  normal  in- 
stinct. As  a  matter  of  fact,  supported  by  everyday 
experience,  no  causes  are  productive  of  more  dis- 
orders of  digestion  than  the  free  indulgence  in  des- 
serts and  sweets  by  young  children.  It  is  a  constantly 
increasing  tendency,  not  easily  controlled  as  a  child 
grows  older ;  and  in  early  childhood  the  only  safe  rule 
is  to  give  none  at  all. 


THE    DIET    OF    OLDER    CHILDREN  141 

FEUITS 

Are  fruits  an  essential  or  important  part  of  the 
diet? 

They  are  a  very  important  part.  They  are  par- 
ticularly useful  for  the  effect  they  have  upon  the  bow- 
els. It  is  important  that  they  should  be  selected  with 
care  and  given  with  much  discretion,  especially  in 
cities.  In  the  country,  where  fruit  is  absolutely 
fresh,  a  somewhat  gTcater  latitude  may  be  allowed 
than  is  given  below. 

What  fruits  may  safely  he  given  to  children  up  to 
five  years  old? 

As  a  general  rule,  only  cooked  fruits  and  the 
juices  of  fresh  fruits. 

What  fruit  juices  may  he  used? 

That  from  sweet  oranges  is  the  best,  but  the  fresh 
juice  of  grape  fruit,  peaches^  strawberries,  and  rasp- 
berries may  also  be  used. 

What  cooJced  fruits  may  he  given? 

Stewed  or  baked  apples,  prunes,  pears,  peaches, 
and  apricots. 

What  raw  fruits  are  to  he  particidarly  avoided 
with  young  children? 

The  pulp  of  oranges  or  grape  fruit,  also  cherries, 
berries,  bananas,  pineapple  and  raw  apples,  es- 
pecially between  meals. 


142   THE  CAEE  AND  FEEDING  OF  CHILDREN 

What  precautions  should  he  emphasized  regard- 
ing the  use  of  fruits? 

That  they  should  be  used  with  greater  care  in 
hot  weather  and  with  children  who  are  prone  to 
attacks  of  intestinal  indigestion. 

What  symptoms  indicate  that  fruits  should  he 
avoided  ? 

A  tendency  to  looseness  of  the  bowels  with  the 
discharge  of  mucus,  or  frequent  attacks  of  abdominal 
pain  or  stomach-ache. 

Is  there  any  special  choice  of  'ineals  at  which 
fruit  should  he  given  f 

The  fruit  juice  given  early  in  the  morning,  upon 
an  empty  stomach,  works  more  actively  upon  the 
bowels  than  if  it  is  given  later  in  the  day. 

It  is  not,  as  a  rule,  wise  to  give  cream  or  milk 
with  sour  fruits.  Usually  the  fruit  is  best  given  at 
the  mid-day  meal,  as  a  dessert,  at  a  time  when  no 
milk  is  taken.  It  is  in  all  cases  important  that  the 
quantity  of  fruit  should  be  moderate. 

What  hesides  water  and  milk  should  a  child  he 
allowed  to  drink  and  ivhat  should  he  forhidden? 

Tea,  coffee,  wine,  beer  and  cider  in  all  quantities 
and  in  all  forms  should  be  forbidden  to  young  chil- 
dren below  puberty.  Cocoa  which  is  made  very 
weak,  i.  e.,  almost  all  milk,  is  often  useful  as  a  hot 


INDIGESTION  IN  OLDEE  CHILDREN  143 


drink.  Lemonade,  soda-water,  etc.,  should  if  pos- 
sible* be  deferred  until  the  tenth  year.  A  free  in- 
dulgence in  things  of  this  kind  should  never  be  per- 
mitted with  children  of  seven  or  eight  years. 


INDIGESTION  IN   OLDER  CHILDREN 

What  are  the  different  ways  in  which  indigestion 
shows  itself  in  children? 

First,  in  acute  disturbances  which  last  for  a  few 
days  only;  and,  secondly,  in  chronic  disturbances 
which  may  continue  for  weeks  or  months. 

Which  of  the  two  forms  of  indigestion  is  more 
likely  to  impair  seriously  the  health  of  the  child? 

Chronic  indigestion;  for  since  the  cause  is  not 
recognized  it  often  goes  on  for  months  and  even 
years  unchecked. 

What  are  the  symptoms  of  acute  indigestion? 

These  are  familiar  and  easily  recognized.  They 
are  vomiting,  pain,  undigested  movements  from  the 
bowels,  often  fever  and  considerable  prostration. 

Such  attacks  are  usually  traceable  to  their 
proper  cause,  the  removal  of  which  is  followed  by 
prompt  recovery. 


144      THE   CAEE   AND   FEEDING   OF   CHILDEEN 

^yllat  are  the  common  causes  of  acute  indir 
gestion  ? 

This  is  frequently  due  to  overeating,  to  indul- 
gence in  some  special  article  of  improper  food,  or  to 
eating  heartily  when  overtired.  Acute  indigestion 
often  marks  the  beginning  of  some  acute  general 
illness. 

How  should  acute  indigestion  he  managed? 

One  should  bear  in  mind  that  for  the  time  being 
the  digestive  organs  have  stoj)ped  work  altogether. 
The  important  thing,  therefore,  is  to  clear  out  from 
the  intestines  all  undigested  food  by  some  active 
cathartic,  such  as  castor  oil.  The  stomach  has 
usually  emptied  itself  by  vomiting.  All  food  should 
be  stopped  for  from  twelve  to  thirty-six  hours, 
according  to  the  severity  of  the  attack,  only  water 
being  given. 

At  the  end  of  this  time  is  it  safe  to  begin  with 
the  former  diet? 

Xo ;  for  such  a  procedure  is  almost  certain  to 
cause  another  attack  of  indigestion.  At  first  only 
broth,  thin  gruel,  very  gTcatly  diluted  milk,  or  whey 
should  be  given.  The  diet  may  be  very  slowly  but 
gradually  increased  as  the  child's  appetite  and 
digestion  improve,  but  in  most  cases  a  week  or  ten 
days  should  elapse  before  the  full  diet  is  resumed. 


INDIGESTION  IN  OLDEK  CHILDEEN  145 

What  are  the  symptoms  of  chronic  indigestion? 
'  These,  although  familiar,  are  not  so  easily  dis- 
tinguished and  are  very  often  attributed  to  the 
wrong  cause.  There  are  usually  general  symptoms 
such  as  indisposition,  disturbed  sleep,  grinding  of 
the  teeth,  fretfulness,  languor,  loss  of  weight  and 
anaemia.  There  are  besides  local  symptoms:  flat- 
ulence, abdominal  pain,  abdominal  distention,  con- 
stipation, or  looseness  of  the  bowels  with  mucus  in 
the  stools,  foul  breath,  coated  tongue,  loss  of  appe- 
tite, or  an  abnormal,  capricious  appetite.  Such 
symptoms  are  often  wrongly  ascribed  to  intestinal 
worms. 

What  are  the  common  causes  of  chronic  indi- 
gestion f 

This  is  generally  the  result  of  a  bad  system  of 
feeding,  either  the  prolonged  use  of  improper  food 
or  of  improper  methods  of  feeding. 

Examples  of  bad  methods  of  feeding  are,  coaxing 
or  forcing  to  eat,  rapid  eating  with  insufficient  mas- 
tication, eating  between  meals,  allowing  a  child  to 
have  his  own  way  in  selecting  his  food,  as  when  he 
lives  largely  upon  a  single  article  of  diet.  Things  to 
be  considered  under  the  head  of  improper  food  are, 
indulgence  in  sweets,  desserts,  etc.,  the  use  of  imper- 
fectly cooked  foods,  especially  cereals  and  vege- 
tables, and  of  raw  or  stale  fruits. 


146       THE    CARE    AND    FEEDING   OF   CHILDREN 

Is  it  not  true  that  a  diet  or  a  special  article 
of  food  which  does  not  mahe  a  child  ill  is  proof 
that  such  a  diet  or  such  a  food  is  proper  for  a 
child? 

Bj  no  means;  with  many  people  the  only  guide 
in  feeding  children  is  that  the  article  in  question 
did  not  make  the  children  sick,  therefore  it  is  allow* 
able.  This  is  a  very  bad  principle.  A  better  one 
is  to  adopt  such  a  diet  as  will  nourish  the  child's 
body  with  the  least  possible  tax  upon  his  digestive 
organs;  in  other  words,  to  exclude  articles  which 
experience  has  shown  to  be  injurious  to  most  chil- 
dren. 

How  should  chronic  indigestion  he  managed^ 
This  is  a  much  more  difficult  matter  than  the 
treatment  of  acute  indigestion,  for,  as  it  is  usually 
the  result  of  the  prolonged  use  of  improper  food  or 
of  an  improper  method  of  feeding,  a  cure  can  be 
accomplished  only  by  a  discovery  and  removal  of 
the  cause. 

Is  chronic  indigestion  curahlef 

In  the  vast  majority  of  cases  it  is  so,  but  only 
by  faithfully  observing  for  a  long  period  the  rules 
for  simple  feeding  laid  dovni  elsewhere.  One  of 
the  greatest  difficulties  in  the  way  of  recovery  is 
that  parents  and  nurses  are  unwilling  to  follow  a 


GENEEAL  RULES  TO  BE  OBSERVED  IN  FEEDING  147 


restricted  diet  long  enough  to  secure  a  complete 
cure,  or  to  change  radically  their  methods  of  feed- 
ing, but  expect  the  child  to  recover  by  sim.p]y  taking 
medicine. 

For  how  long  a  period  is  it  necessary  to  continue 
very  careful  feeding'^ 

In  any  case  it  must  be  done  for  several  months ; 
with  most  children  for  two  or  three  years;  with 
some,  throughout  childhood,  for  with  them  the 
slightest  deviation  from  established  rules  is  sure  to 
provoke  a  relapse. 

Is  not  medicine  useful  f 

It  is  undoubtedly  of  assistance  for  the  relief  of 
some  symptoms,  but  the  essential  thing  is  proper 
feeding,  without  which  nothing  permanent  can  be 
accomplished. 


GENERAL  RULES   TO   BE   OBSERVED   IN 
FEEDING 

Bad  habits  of  eating  are  readily  acquired  but 
difficult  to  break. 

Young  children  should  not  be  allowed  to  play 
with  their  food,  nor  should  the  habit  be  formed  of 
amusing  or  diverting  them  while  eating,  because  by 
these  means  more  food  is  taken. 


148       THE    CAEE    AND    FEEDING   OF   CHILDREN 

Older  children  should  not  be  permitted  to  make 
an  entire  meal  of  one  thing,  no  matter  how  proper 
this  maj  be. 

Children  who  are  allowed  to  have  their  own 
way  in  matters  of  eating  are  verv  likely  to  be  badly 
trained  in  other  respects ;  while  those  who  have 
been  properly  trained  in  their  eating  can  usually 
be  easily  trained  to  do  anything  else  that  is  im- 
portant. 

Learning  to  eat  proper  things  in  a  proper  way 
forms,  therefore,  a  large  part  of  a  child's  early  edu- 
cation. If  careful  training  in  these  matters  is  begun 
at  the  outset  and  continued,  the  results  will  well 
repay  the  time   and   effort   required. 

Whether  the  child  feeds  himself  or  is  fed  by  the 
nurse,  the  following  rules  should  be  observed : 

1.  Food  at  regular  hours  only;  nothing  between 
meals. 

2.  Plenty  of  time  should  be  taken.  On  no  ac- 
count should  the  child  bolt  his  food. 

3.  The  child  must  be  taught  to  chew  his  food. 
Yet  no  matter  how  much  pains  are  taken  in  this 
respect,  mastication  is  very  imperfectly  done  by  all 
children;  hence  up  to  the  seventh  year  at  least,  all 
meats  should  be  very  finely  cut,  all  vegetables 
mashed  to  a  pulp,  and  all  grains  cooked  very  soft. 

4.  Children  should  not  be  continually  urged  to 


GENEEAL  EXILES  TO  BE  OBSEEVED  IN  FEEDING     149 

eat. if  they  are  disinclined  to  do  so  at  their  regular 
hours  of  feeding,  or  if  the  appetite  is  habitually 
poor,  and  under  no  circumstances  should  a  child  be 
forced  to  eat. 

5.  Indigestible  food  should  never  be  given  to 
tempt  the  appetite  v^hen  the  ordinary  simple  food  is 
refused;  food  should  not  be  allowed  between  meals 
because  it  is  refused  at  meal-time. 

6.  One  serious  objection  to  allowing  young  chil- 
dren highly  seasoned  food,  entrees,  jellies,  pastry, 
sweets,  etc.,  even  in  such  small  amounts  as  not  to 
upset  the  digestion,  is  that  children  thus  indulged 
soon  lose  appetite  for  the  simple  food  which  pre- 
viously was  taken  with  relish. 

7.  If  there  is  any  important  article  of  a  simple 
diet  such  as  milk,  meat,  cereals,  or  vegetables,  which 
a  child  habitually  refuses,  this  should  always  be 
given  first  at  the  meal  and  other  food  withheld 
until  it  is  disposed  of.  Children  so  readily  form 
habits  of  eating  only  certain  things  and  refusing 
others  that  such  an  inclination  should  be  checked 
earlv. 

8.  If  an  infant  refuses  its  food  altogether,  or 
takes  less  than  usual,  the  food  should  be  examined 
to  see  if  this  is  right.  Then  the  mouth  should  be 
inspected  to  see  if  it  is  sore.'  If  neither  of  these 
things  is  the  cause,  the  food  should  be  taken  away 


150       THE    CAEE    AND    FEEDING   OF   CHILDREN 

and  not  offered  again  until  the  next  feeding  time 
comes. 

9.  In  any  acute  illness  the  amount  of  food  should 
be  much  reduced  and  the  food  made  more  dilute 
than  usual.  If  there  is  fever,  no  solid  food  should 
be  given.  If  the  child  is  already  upon  a  milk  diet, 
this  should  be  diluted. 

10.  In  very  hot  weather  the  same  rules  hold,  to 
give  less  food,  particularly  less  solid  food,  and  more 
water. 

FOOD  FORMULAS 
Beef  Juice. — One  pound  of  rare  round  steak, 
cut  thick,  slightly  broiled,  and  the  juice  pressed  out 
by  a  lemon-squeezer,  or,  better,  a  meat-press.  From 
two  to  four  ounces  of  juice  can  generally  be  ob- 
tained. This,  seasoned  with  salt,  may  be  given 
cold,  or  warmed  by  placing  the  cup  which  holds  it 
in  warm  water.  It  should  not  be  heated  sufficiently 
to  coagulate  the  albumin  which  is  in  solution,  and 
which  then  appears  as  flakes  of  meat  floating  in 
the  fluid. 

Beef  Juice  by  the  Cold  Process, — One  pound  of 
finely  chopped  round  steak,  six  ounces  of  cold  water, 
a  pinch  of  salt;  place  in  a  covered  jar  and  stand  on 
ice  or  in  a  cold  place,  ^ve  or  six  hours  or  overnight. 
It    is    well    to    shake    occasionally.      This    is    now 


FOOD  FORMULAS  151. 

strained  and  all  the  juice  squeezed  out  by  placing 
tTie  meat  in  coarse  muslin  and  twisting  it  very  hard. 
It  is  then  seasoned  and  fed  like  the  above. 

Beef  juice  so  made  is  not  quite  as  palatable  as 
that  prepared  from  broiled  steak,  but  it  is  even  more 
nutritious,  and  is  more  economical,  as  fully  twice  as 
much  juice  can  be  obtained  from  a  given  quantity  of 
meat.  Beef  juice  prepared  in  either  of  these 
ways  is  greatly  to  be  preferred  to  the  beef  extracts 
sold. 

Mutton  Broth. — One  pound  of  finely  chopped 
lean  mutton,  including  some  of  the  bone,  one  pint 
cold  water,  pinch  of  salt.  Cook  for  three  hours  over 
a  slow  fire  down  to  half  a  pint,  adding  water  if 
necessary;  strain  through  muslin,  and  when  cold 
carefully  remove  the  fat,  adding  more  salt  if  re- 
quired. It  may  be  fed  warm,  or  cold  in  the  form 
of  a  jelly. 

A  very  nutritious  and  delicious  broth  is  made  by 
thickening  this  with  cornstarch  or  arrowroot,  cook- 
ing for  ten  minutes  and  then  adding  three  ounces  of 
milk,  or  one  ounce  of  thin  cream,  to  a  half  pint  of 
broth. 

Chicken,  Veal,  and  Beef  Broths. — These  are 
made  and  used  in  precisely  the  same  manner  as  mut- 
ton broth. 


152   THE  CARE  AND  FEEDING  OF  CHILDREN 

Scraped  Beef  or  Meat  Pulp. — A  piece  of  rare 
round  or  sirloin  steak,  the  outer  part  having  been  cut 
away,  is  scraped  or  shredded  with  a  knife ;  from  one 
teaspoonful  to  one  tablespoonful  may  be  given,  well 
salted,  to  a  child  of  eighteen  months.  Scraping  is 
much  better  than  cutting  the  meat  fine. 

For  this  on  a  large  scale,  as  in  institutions,  a 
Hamburg-steak  cutter  may  be  employed. 

Junketj,  or  Curds  and  Whey. — One  pint  of  fresh 
cow's  milk,  warmed  to  blood  heat ;  pinch  of  salt ;  one- 
half  tablespoonful  of  granulatftd  sugar ;  add  two  tea- 
spoonfuls  of  Fairchild's  essence  of  pepsin,  or  liquid 
rennet,  or  one  junket  tablet  dissolved  in  water;  stir 
for  a  moment,  and  then  allow  it  to  stand  at  the  tem- 
perature of  the  room  for  twenty  minutes,  or  until 
firmly  coagulated ;  place  in  the  ice  box  until  thor 
oughly  cold.  For  older  children  this  may  be  seasoned 
with  grated  nutmeg. 

Whey. — The  coagulated  milk  prepared  as  above, 
omitting  the  sugar,  is  broken  up  with  a  fork  and  the 
whev  strained  off  through  muslin.  If  some  stimu- 
lant  is  desired,  a  little  sherry  wine  may  be  added. 
Whey  is  useful  in  many  cases  of  acute  indigestion 
with  vomiting,  but  not  in  diarrhoea. 

Barley  Water. — One  level  tablespoonful  of  barley 
flour  is  thoroughly  blended  with  a  little  cold  water 


FOOD  FORMULAS  153 

and  added,  stirring,  to  ten  ounces  of  boiling  water 
containing  a  pinch  of  salt.  This  is  cooked  for  thirty 
minutes  in  a  double  boiler  and  then  strained. 
Enough  water  should  then  be  added  to  bring  the 
whole  up  to  one  pint. 

Barley  Gruel  or  Barley  Jelly. — This  is  made  in 
the  same  manner  as  the  above,  but  from  two  to  four 
level  tablespoonfuls  of  the  flour  are  used,  according 
to  the  thickness  of  the  gruel  desired. 

Either  barley  water  or  barley  jelly  may  be  made 
from  the  grains.  Eor  barley  water,  use  one  heaping 
tablespoonful  of  pearl  barley  which  has  been  soaked 
four  or  five  hours,  or  overnight,  one  pint  of  water,  a 
pinch  of  salt.  This  is  boiled  steadily  for  four  hours, 
adding  water  from  time  to  time  to  keep  the  quantity 
up  to  one  pint.    It  is  then  strained  through  muslin. 

For  barley  gruel  or  barley  jelly  use  from  two  to 
four  tablespoonfuls  of  pearl  barley. 

Rice,  Wheat,  or  Oat  Water. — These  are  made 
from  rice,  wheat,  or  oat  flour  exactly  as  barley  water, 
above  described.  Like  the  barley  water  they  may 
also  be  made  from  the  grains,  using  the  same  propor- 
tions. 

Gruel  or  Jelly  from  Bice,  Wheat,  or  Oats. — 
These  are  made  from  the  flours  or  grains  as  has  been 
described  for  barley  gruel. 


154      THE    CAEE    AND    FEEDING    OF    CHILDEEN 

For  the  wheat  preparations,  ordinary  wheat  flour 
or  wheaten  grits  may  be  used. 

For  the  rice  preparations  the  ordinary  rice  grains 
or  rice  flonr  may  he  used. 

For  the  oat  preparations,  either  oat  flour  or  any 
of  the  commonly  employed  forms  of  oatmeal  may  be 
used. 

When  any  of  these  farinaceous  foods  are  to  be 
mixed  with  milk,  the  milk  should  be  added  directly 
after  removing  the  gruel  from  the  fire,  and  stirred 
two  or  three  minutes. 

Albumin  Water. — The  white  of  one  fresh  egg; 
half  a  pint  of  cold  water ;  pinch  of  salt ;  tea  spoonful 
of  brandy.  This  should  be  shaken  thoroughly  and 
fed  cold  either  with  a  spoon  or  from  a  bottle.  It  is 
useful  in  cases  of  vomiting,  and  can  sometimes  be 
retained  by  a  very  irritable  stomach. 

Lime-Water, — One  heaping  teaspoonful  of  slaked 
lime;  one  quart  boiled  or  distilled  water;  place  in  a 
corked  bottle  and  shake  thorouffhlv  two  or  three  times 
during  the  first  hour.  The  lime  should  then  be  al- 
lowed to  settle,  and  after  twenty-four  hours  the  upper 
clear  fiuid  carefully  poured  or  siphoned  off  for  use. 

Dried  Bread. — Either  stale  or  fresh  bread  may  be 
used ;  it  is  cut  in  thin  slices  and  placed  on  top  of  the 


FOOD  FORMULAS  155 

stoye-pr  in  the  oven,  with  the  door  open,  and  quickly 
dried  until  it  is  crisp,  but  not  browned.  It  is  in 
many  respects  preferable  to  crackers  for  little  chil- 
dren. 

Coddled  Egg. — A  fresh  egg,  shell  on,  is  placed  in 
boiling  water  which  is  immediately  after  removed 
from  the  fire.  The  egg  then  cooks  slowly  in  the 
water,  which  gradually  cools,  for  seven  or  eight  min- 
utes, when  the  white  should  be  about  the  consistency 
of  jelly.  For  a  delicate  digestion  the  white  only 
should  be  given,  with  salt  5  it  can  be  easily  separated 
from  the  yolk. 


PART    IV 
MISCELLAE^EOUS 


IV 
MISCELLANEOUS 

THE   BOWELS 

How  many  movements  daily  should  an  infant 
have  during  the  first  feiv  weeJcs  of  life? 

Usually  two  or  three  a  day  for  the  first  week, 
and  then  one  or  two  each  day. 

How  many  after  a  child  is  a  month  old? 

A  healthy  child  should  have  at  least  one  move- 
ment each  day;  many  have  two  and  some  more  than 
two ;  but  it  is  the  character  of  the  stools  rather  than 
their  number  which  is  to  be  taken  as  the  evidence 
of  perfect  digestion. 

What  is  the  appearance  of  a  healthy  movement 
of  a  child  who  is  taking  nothing  hut  milk  f 

It  is  soft,  yellow,  and  smooth,  containing  no 
lumps. 

When  are  the  stools  dark  hrown  or  hlackf 
While  taking  bismuth,  iron,  and  sometimes  when 
taking  much  meat  or  beef  juice;  also  while  taking 
many  of  the  prepared  foods-      They  may  be  dark 

159 


160   THE  CAEE  AND  FEEDING  OF  CHILDEEN 

brown  or  black  from  blood.     This  last  is  a  condition 
which  may  indicate  serious  illness. 

How  "/nay  a  child  he  trained  to  he  regular  in  the 
action  of  its  howelsf 

By  endeavoring  to  have  them  move  at  exactly 
the  same  time  every  day. 

At  what  age  may  an  infant  he  trained  in  this 
way  ? 

Usnallv  bv  the  second  month  if  training:  is  be- 
gun  early. 

What  is  the  hest  method  of  training? 

A  small  chamber,  abont  the  size  of  a  pint  bowl, 
is  placed  between  the  nurse's  knees,  and  upon  this 
the  infant  is  held,  its  back  being  against  the  nurse's 
chest  and  its  body  firmly  supported.  This  should  be 
done  twice  a  day,  after  the  morning  and  afternoon 
feedings,  and  always  at  the  same  hour.  At  first 
there  may  be  necessary  some  local  irritation,  like 
that  produced  by  tickling  the  anus  or  introducing 
just  inside  the  rectum  a  small  cone  of  oiled  paper 
or  a  piece  of  soap,  as  a  suggestion  of  the  purpose 
for  which  the  baby  is  placed  upon  the  chamber; 
but  in  a  surprisingly  short  time  the  position  is  all 
that  is  required.  With  most  infants  after  a  few 
weeks  the  bowels  will  move  as  soon  as  the  infant  is 
placed  on  the  chamber. 


SLEEP  161 

-  What  advantage  has  such  training? 
It  forms  the  habit  of  having  the  bowels  move 
regularly  at  the  same  hour,  which  is  a  matter  of 
great  importance  in  infancy  and  makes  regularity 
in  childhood  much  easier.  It  also  saves  the  nurse 
much  trouble  and  labour. 

SLEEP 

Should  a  child  sleep  in  the  same  hed  with  its 
mother  or  nurse? 

Under  no  circumstances,  if  this  can  possibly  be 
avoided.  Very,  young  infants  have  often  been 
smothered  by  their  mothers  by  overlying  during 
sleep.  If  the  infant  sleeps  with  the  mother,  there 
is  always  the  temptation  to  frequent  nursing  at 
night,  which  is  injurious  to  both  mother  and  child. 
Older  children  also  should,  if  possible,  have  separate 
beds;  many  contagious  diseases  and  bad  habits  are 
contracted  by  children  sleeping  together. 

Hoiu  should  an  infant's  hed  he  prepared? 

The  mattress  should  be  firm  but  soft,  the  pillow 
very  thin,  and  the  covering  not  excessive.  A  baby 
should  not  be  allowed  to  sleep  always  in  the  same 
position,  but  should  be  changed  from  side  to  side. 
Hair  pillows  are  useful  in  summer  and  for  children 
who  perspire  very  much. 
11 


162      THE    CAEE    AXD    FEEDIXQ   OF   CHILDEEN 

How  much  sleep  is  natural  for  a  newly-horn 
baby? 

A  babj  with  a  good  digestion  and  proper  food 
will  usually  sleep  at  this  period  about  nine  tenths 
of  the  time. 

How  mucli  should  a  baby  sleep  at  six  months? 
About  two  thirds  of  the  time. 

Up  to  what  age  should  an  older  child  take  a  nap 
during  the  day? 

Always  until  four  years  old,  and  if  possible 
until  seven  or  eight  years  old. 

At  what  age  may  an  infant  go  all  night  with- 
out feeding? 

After  ^\e  months  a  healthy  child  should  not  be 
fed  or  nursed  between  10  p.  m.  and  6  a.  m.  Some 
children  at  this  age  habitually  go  from  6  p.  m.  to  6 
A.  M.  without  feeding,  and  thrive  well  on  this  regime. 

At  two  years  a  child  can  easily  go  from  6  p.  m. 
to  6  A.  M.  without  feeding. 

How  should  a  baby  be  put  to  sleep? 

The  room  should  be  darkened  and  quiet,  the 
child's  hunger  satisfied,  and  the  child  made  gen- 
erally comfortable  and  laid  in  its  crib  while  awake. 

Is  rocking  necessary? 

By  no  means.     It  is  a  habit  easily  acquired,  but 


SLEEP  163. 

hard  to  break,  and  a  very  useless  and  sometimes 
injurious  one.  Tlie  same  may  be  said  of  sucking 
a  rubber  nipple,  or  ''  pacifier,"  and  all  other 
devices  for  putting  children  to  sleep. 

What  are  the  principal  causes  of  disturbed- 
sleep  f 

As  quiet  peaceful  sleep  is  a  sign  of  perfect 
health,  disorders  of  sleep  may  be  produced  by  almost 
anything  which  is  wrong  with  the  child. 

1.  Habitual  disturbance  of  sleep  in  infants  is 
most  frequently  associated  with  the  food  or  feeding. 
It  may  be  from  the  discomfort  of  chronic  indigestion 
due  to  improper  food.  In  bottle-fed  infants  it  is 
often  the  result  of  overfeeding;  in  those  who  are 
nursed  it  is  often  due  to  hunger.  A  common  cause- 
is  frequent  night  feeding ;  an  infant  who  is  fed  three 
or  four  times  during  the  night  is  almost  invariably 
a  bad  sleeper. 

2.  Disturbed  sleep  or  sleeplessness  may  be  due 
to  causes  purely  nervous.  Such  are  bad  habits  ac- 
quired by  faulty  training;  as  when  the  nursery  is- 
lighted  and  the  child  taken  from  its  crib  whenever 
it  wakes  or  cries;  or  when  some  of  the  contrivances 
for  inducing  sleep  have  been  used.  Any  excitement 
or  romping  play  just  before  bedtime,  and  fear& 
aroused  by  pictures  or  stories,  are  frequent  causes^ 


164      THE    CAEE    AND    FEEDING   OF   CHILDREN 

■Children  who  inherit  from  their  parents  a  nervous 
<!onstitiition  are  especially  likely  to  suffer  thus. 

3.  There  may  be  physical  discomfort  from  cold 
feet,  insufficient  or  too  much  clothing,  or  want  of 
fresh  air  in  the  sleeping  room. 

4.  Interference  with  breathing  due  to  obstruc- 
tion from  large  tonsils  or  adenoids.  These  cause 
^eat  restlessness  and  lead  a  child  to  assume  many 
■different  postures  during  sleep,  often  lying  upon  the 
face  or  upon  the  hands  and  knees. 

5.  Chronic  pains  or  frequently  recurring  night 
pains  may  be  causes  of  disordered  sleep,  when  a 
-child  wakes  with  a  sudden  sharp  cry.  In  infants 
this  is  most  often  due  to  scurvy,  sometimes  to 
rsyphilis.  In  older  children  it  may  be  the  earliest 
symptom  of  disease  of  the  hip  or  spine. 

6.  Sleeplessness  and  disturbed  sleep  are  frequent 
"whenever  the  general  condition  falls  much  below  a 
healthy  standard;  e.  g.,  in  infants  who  are  not 
thriving  and  in  children  suffering  from  marked 
^nsemia. 

Hoiu  are  children  who  sleep  too  little,  or  whose 
sleep  is  constantly  disturhed,  to  he  treated? 

ITever  by  the  use  of  soothing  sirups  or  other 
medicines.  Successful  treatment  consists  in  the 
discovery  and  removal  of  the  cause. 


EXERCISE  165 

.   .Do  children  ever  sleep  too  much? 

It  is  doubtful  if  healthy  children  ever  do.  Ex- 
cessive sleep  is  an  important  symptom  of  some  dis- 
eases of  the  brain.  Otherwise  it  seldom  if  ever 
occurs  unless  soothing  sirups  or  other  drugs  have 
been  given. 

EXERCISE 

'  Is  exercise  important  for  infants? 
It  is  as  necessary  for  them  as  for  older  children^ 

How  is  it  obtained? 

A  young  baby  gets  its  exercise  by  screaming, 
waving  its  arms,  kicking,  etc.  The  clothing  should 
not  be  so  tight  as  to  make  these  movements  impos- 
sible. At  least  twice  a  day  the  infant  should  be 
allowed  for  fifteen  or  twenty  minutes  the  free  use  of 
its  limbs  by  permitting  it  to  lie  upon  a  bed  in  a 
warm  room,  with  all  clothing  except  the  shirt,  stock- 
ings, and  napkin  removed.  ^  Later,  when  in  short 
clothes,  the  baby  may  be  put  upon  a  thick  blanket 
or  quilt  laid  upon  the  floor,  and  be  allowed  to  tumble 
about  at  will.  A  nursery  pen  two  feet  high,  made 
to  surround  a  mattress,  is  an  excellent  device  and 
makes  a  convenient  box  stall  for  the  young  animal, 
where  it  can  learn  to  use  both  its  arms  and  legs  with- 


166      THE    CAEE    AXD    FEEDING   OF   CHILDEEN 


out  the  danger  of  injurv.  Only  bv  exercise  such  as 
this  do  the  muscles  have  an  opportunity  to  develop 
properly. 


THE    CRY 


When  is  cryiyig  useful? 

In  the  newly  born  infant  the  cry  expands  the 
lungs,  and  it  is  necessary  that  it  should  be  repeated 
for  a  few  minutes  every  day  in  order  to  keep  them 
well  expanded. 

How  much  crying  is  normal  for  a  very  young 
habyf 

From  fifteen  to  thirty  minutes  a  day  is  not  too 
much. 

What  is  the  nature  of  this  cry? 

It  is  loud  and  strong.  Infants  get  red  in  the 
face  with  it;  in  fact,  it  is  a  scream.  This  is  neces- 
sary for  health.     It  is  the  baby's  exercise. 

When  is  a  cry  ahnormal? 

When  it  is  too  long  or  too  frequent.  The  ab- 
normal cry  is  rarely  strong,  often  it  is  a  moaning 
or  a  worrying  cry,  sometimes  only  a  feeble  whine. 

What  are  the  main  causes  of  such  crying? 
Pain,  temper,  hunger,  illness,  and  habit. 


THE    CEY  167 

.  ^Yhat  is  the  cry  of  pain? 

"It  is  usually  strong  and.  sharp,  but  not  generally 
continuous.  It  is  accompanied  by  contraction  of  the 
features,  drawing  up  of  the  legs,  and  other  symptom* 
of  distress. 

What  is  the  cry  of  hunger? 

It  is  usually  a  continuous,  fretful  cry,  rarely 
strong  and  lusty. 

What  is  the  ay  of  temper? 

It  is  loud.  and.  strong  and  accompanied  by  kick- 
ing or  stiffening  of  the  body,  and  is  usually  violent. 

What  is  the  cry  of  illness? 

There  is  usually  more  of  fretfulness  and  moan- 
ing than  real  crying,  although  crying  is  excited  by- 
very  slight  causes. 

What  is  the  cry  of  indulgence  or  from  liahit? 

This  is  often  heard,  even  in  very  young  infants^ 
who  cry  to  be  rocked,  to  be  carried  about,  sometimes 
for  a  light  in  the  room,  for  a  bottle  to  suck,  or  for 
the  continuance  of  any  other  bad  habit  which  has- 
been  acquired. 

Hoiu  can  we  he  sure  that  a  child  is  crying  to  he 
indulged  f 

If  it  stops  immediately  when  it  gets  what  it 
wants,  and  cries  when  it  is  withdrawn  or  withhekL 


168      THE    CARE    AND    FEEDING   OF   CHILDREN 

What  should  he  done  if  a  hahy  cries  at  night? 

One  should  get  up  and  see  that  the  child  is  com- 
fortable— the  clothing  smooth  under  the  body,  the 
hands  and  feet  warm,  and  the  napkin  not  wet  or 
soiled.  If  all  these  matters  are  properly  adjusted 
and  the  child  simply  crying  to  be  taken  up,  it 
should  not  be  further  interfered  with.  If  the 
night  cry  is  habitual  some '  other  cause  should  be 
sought. 

How  is  an  infant  to  he  managed  that  cries  from 
temper,  hahit,  or  to  he  indulged? 

It  should  simply  be  allowed  to  "  cry  it  out." 
This  often  requires  an  hour,  and,  in  extreme  cases, 
two  or  three  hours.  A  second  struggle  will  seldom 
last  more  than  ten  or  fifteen  minutes,  and  a  third 
will  rarely  be  necessary.  Such  discipline  is  not  to 
be  carried  out  unless  one  is  sure  as  to  the  cause  of 
the  habitual  crying. 

7s  it  nicely  that  rupture  will  he  caused  from 
crying  f 

ITot  in  young  infants  if  the  abdominal  band  is 
properly  applied,  and  not  after  a  year  under  any 
circumstances. 

LIFTIITG  CHILDEEIT 

How  should  a  young  hahy  he  lifted  from  its  hed? 
The  right  hand  should  grasp  the  clothing  below 


THE  TEMPERATURE  169 

the  feet,  and  the  left  hand  should  be  slipped  beneath 
the' i'nf ant's  body  to  its  head.  It  is  then  raised  upon 
the  left  arm. 

What  is  the  advantage  of  this? 

The  entire  spine  is  supported,  and  no  undue 
pressure  is  made  upon  the  chest  or  abdomen,  as 
often  happens  if  the  baby  is  grasped  around  the 
body  or  under  the  arms. 

How  should  a  child  old  enough  to  run  about  he 
lifted? 

Always  by  placing  the  hands  under  the  child's 
arms,  and  never  by  the  wrists. 

What  injury  may  he  inflicted  hy  lifting  the  child 
hy  the  lurists  or  hands? 

Often  serious  injury  is  done  to  the  elbow  or 
shoulder  joints. 

THE    TEMPEKATlfEE 

What  is  the  normal  temperature  of  an  infant? 

The  normal  temperature  varies  more  than  in 
adults.  In  the  rectum  it  usually  fluctuates  between 
98°  and  99.5°  F. ;  a  rectal  temperature  of  97.5°  F. 
or  of  100.5°  r.  is  of  no  importance  whatever  un- 
less it  continues. 


170      THE    CAEE    AND    FEEDING   OF   CHILDEEN 

Where  should  the  tem-perature  of  infants  and 
young  children  he  tahen? 

The  rectuirL  is  altogether  the  best  place,  and  next 
to  this  the  groin.  The  rectal  temperature  is  from 
half  a  degree  to  a  degree  higher  than  that  in  the 
groin. 

How  long  should  the  thermometer  he  left  in 
place  to  tahe  the  temperature? 

Two  minutes  in  the  rectum,  and  five  minutes  in 
the  groin. 

Is  the  temperature  of  a  young  child  a  good  guide 
as  to  the  severity  of  its  symptoms  in  illness? 

As  a  rule  it  is.  A  temperature  of  100*^  to  102° 
r.  commonly  means  a  mild  illness,  and  one  of  104° 
F.  or  over  a  serious  one.  The  duration  of  the  fever 
is,  however,  even  more  important  than  the  height  of 
the  temperature.  It  should  be  remembered  that  in 
all  young  children  slight  causes  often  produce  a  high 
temperature  which  '^asts  for  a  few  hours ;  one  should 
not  therefore  be  unduly  alarmed  unless  the  tempera- 
ture continues  high,  or  is  accompanied  by  other  im- 
portant signs  of  illness. 

75  not  a  high  temperature  a  more  serious  symp- 
tom in  a  young  child  than  in  an- adult? 

The  opposite  is  rather  the  case.  Young  children 
are  extremely  sensitive  to  conditions  which  produce 


NEEVOUSNESS  171 


fever,  and  the  thermometer  often  gives  an  exagger- 
at'ed"  idea  of  the  severity  of  the  symptoms.  A  cause 
which  in  an  adult  might  produce  a  temperature  of 
102°  F.  or  103°  F.  in  a  young  child  would  very 
likely  be  accompanied  by  a  temperature  of  104°  or 
105°  F. 

K-EEVOUSN"ESS 

What  are  the  principal  causes  of  excessive  nerv- 
ousness in  infants  and  young  children,  and  what  can 
he  done  to  prevent  this? 

The  most  important  cause  is  the  delicate  struc- 
ture of  the  brain  at  this  time,  and  its  rapid  growth. 
It  grows  as  much  during  the  first  year  as  during  all 
the  rest  of  life.  This  requires  quiet  and  peaceful 
surroundings.  Infants  who  are  naturally  nervous 
should  be  left  much  alone,  should  see  but  few  people, 
should  be  played  with  very  little,  and  should  never 
be  quieted  with  soothing  sirups  or  the  "  pacifier." 

At  ivhat  age  may  playing  with  hahies  he  hegunf 
Babies   under   six   months   old   should   never   be 
played  with;  and  the  less  of  it  at  any  time  the  bet- 
ter for  the  infant. 

^Yhat  harm  is  done  hy  playing  with  very  young 
hahies? 

They    are    made    nervous    and    irritable,    sleep 


172       THE   CAEE    AND    FEEDING   OF   CHILDREN 

badly,    and   suffer   from   indigestion    and   in   many 
other  respects. 

When  may  young  children  he  played  with? 
If  at  all,   in  the  morning,  or  after  the  mid-day 
nap ;  but  never  just  before  bedtime. 

TOYS 

What  points  should  guide  one  in  selecting  toys 
and  playthings  for  an  infant? 

The  instinct  in  a  baby  to  put  everything  into 
the  mouth  is  so  strong  that  nothing  should  be  given 
that  cannot  be  safely  treated  in  this  way.  Hence 
one  should  choose  things  which  are  smooth,  those 
which  can  be  easily  washed,  and  those  which  can- 
not be  swallowed. 

One  should  avoid  (1)  toys  with  sharp  points  or 
corners;  (2)  those  with  loose  parts  that  might  be 
detached  or  broken  off  and  swallowed;  (3)  small 
objects  which  might  be  swallowed  or  pushed  into 
the  nose  or  ear,  such  as  coins,  marbles,  and  safety- 
pins,  also  beads  and  buttons  unless  strung  upon  a 
stout  cord;  (4)  painted  toys;  (5)  those  covered  with 
hair  or  wool.  Infants  have  often  been  severely  in- 
jured by  swallowing  what  they  have  pulled  off 
from  their  small  tov  animals. 


TOYS  173 

What  points  are  to  he  considered  in  selecting  the 
toys  and  playthings  of  a  child  over  two  years  old  f 

It  should  be  remembered  that  toys  are  not 
merely  a  source  of  amusement,  but  that  they  have 
an  educational  value  as  well.  Those  are  therefore 
to  be  preferred  the  use  of  which  develops  the  child's 
imagination,  and  with  which  he  can  be  taught  to 
amuse  himself.  For  boys  nothing  can  surpass 
blocks,  toy  soldiers,  balls,  engines  and  trains  of 
cars;  and  for  girls,  dolls  and  housekeeping  sets. 
The  complicated  mechanical  toys  now  so  much  in 
vogue  usually  give  only  a  momentary  pleasure,  and 
as  soon  as  the  wonder  at  their  operation  has  worn 
off,  they  have  lost  interest  for  the  child  except  that 
which  he  gets  in  breaking  them  to  see  how  the  thing 
worked. 

What  important  things  can  he  taught  children 
with  their  toys  and  how  may  this  he  done? 

The  imagination  may  be  developed,  and  children 
may  be  trained  to  habits  of  neatness,  order  and  regu- 
larity, and  to  concentration  of  mind. 

To  this  end  toys  should  be  kept  in  an  orderly 
way  upon  a  shelf  in  the  nursery  or  in  a  closet, 
never  piled  in  a  miscellaneous  heap  in  the  corner  of 
the  room.  Children  should  select  their  toys  and 
play  with  one  thing  at  a  time,  which  they  should 


174   THE  CAEE  AND  FEEDING  OF  CHILDKEN 

be  taught  to  put  away  in  its  place  before  another 
is  given.  They  should  never  be  allowed  to  have  a 
dozen  things  streAvn  about  the  room  at  one  time, 
with  none  of  which  they  are  occupied. 

KISSING 

Are  {here  any  valid  ohjections  to  hissing  inr 
fants? 

There  are  many  serious  objections.  Tuberculo- 
sis, diphtheria,  syphilis,  and  many  other  gi'ave  dis- 
eases may  be  communicated  in  this  way.  The  kiss- 
ing of  infants  upon  the  mouth  by  other  children, 
by  nurses,  or  by  people  generally,  should  under  no 
circumstances  be  permitted.  Infants  should  be 
kissed,  if  at  all,  upon  the  cheek  or  forehead,  but  the 
less  even  of  this  the  better. 

COJ^VULSIOITS 

What  should  he  done  for  a  child  in  convulsions 
before  a  doctor  arrives? 

Keep  the  child  perfectly  quiet  with  ice  at  the 
head,  put  the  feet  in  a  mustard  bath,  and  roll  the 
entire  body  in  large  towels  which  have  been  dipped 
in  mustard  water  (two  heaping  tablespoonfuls  of 
mustard   to    one   quart   of  tepid   water),    and   have 


FOEEIGN   BODIES  175 


plenty  of  hot  water  and  a  bath  tub  at  hand,  so  that 
the  doctor  can  give  a  hot  bath  if  he  thinks  it  advis- 
able. 

When  is  a  hot  hath  useful? 

If  the  convulsions  have  continued  until  the  pulse 
is  weak,  the  face  very  pale,  the  nails  and  lips  blue, 
and  the  feet  and  hands  cold,  the  hot  bath  will  be 
useful  bv  bringing  blood  to  the  surface  and  relieving 
the  heart,  lungs,  and  brain. 

How  should  the  hath  he  given? 

The  temperature  should  not  be  over  106°  F. ; 
this  should  always  be  tested  by  a  thermometer  if  one 
can  be  obtained.  Without  this  precaution,  in  the  ex- 
citement of  the  moment,  infants  have  frequently 
been  put  into  baths  so  hot  that  serious  and  even  fatal 
burns  have  been  produced.  If  no  thermometer  is 
available  the  nurse  may  plunge  her  arm  to  the  elbow 
into  the  water.  It  should  feel  warm,  but  not  so  hot 
as  to  be  at  all  uncomfortable.  One  half  a  teacupful 
of  powdered  mustard  added  to  the  bath  often  adds 
to  its  efficacy. 

FOREIGN"   BODIES 

What  should  he  done  if  a  foreign  hody  has  heen 
swallowed? 

First,  examine  the  throat  with  the  finger.  If  it 
has  lodged  there  remove  it.     If  it  has  passed  from 


176       THE    CAKE   AND    FEEDING   OF   CHILDREN 

the  throat  it  has  usually  gone  into  the  stomach. 
Next  be  sure  that  the  object  has  actually  been  swal- 
lowed. Often  needless  alarm  is  allayed  by  finding 
in  the  child's  crib  or  elsewhere  the  thing  supposed 
to  have  been  swallowed.  The  stools  should  be  ex- 
amined daily  to  see  if  the  foreign  body  passes  the 
bowel. 

What  further  treatment  is  needed? 

Give  the  child  plenty  of  dry  food,  like  bread, 
potato,  etc.,  but  under  no  circumstances  either  an 
emetic  or  cathartic.  An  infant  may  have  its  usual 
food. 

What  harm  would  a  cathartic  do? 

It  is  likely  to  hurry  the  foreign  body  too  rapidly 
through  the  intestine  and  in  this  way  do  harm; 
otherwise  it  becomes  coated  with  fsecal  matter  and 
passes  the  intestine  usually  without  doing  injury. 

l^ot  only  smooth  objects  such  as  buttons  or  coins 
are  taken  care  of  in  this  manner,  but  even  sharp 
and  pointed  objects  such  as  safety  pins  are  usually 
passed  through  the  bowel  without  causing  pain  or 
inflicting  any  injury. 

How  long  a  time  is  required  for  a  foreign  body 
to  pass  the  bowel? 

In  most  cases  but  three  or  four  days,  occasionally 
a  week  or  ten  days. 


COLIC  177 

What  should  he  done  if  a  child  gets  a  foreign 
body  into  the  ear? 

Unless  this  can  easily  be  removed  with  the 
fingers  it  should  not  be  meddled  with,  for  it  is  likely 
to  be  pushed  farther  into  the  ear.  The  child  should 
be  taken  to  a  physician. 

What  should  he  done  if  there  is  a  foreign  hody 
in  the  nosef 

The  child  should  blow  his  nose  strongly  while 
the  empty  nostril  is  compressed.  Unless  this  re- 
moves it  a  physician  should  be  called.  Meddlesome 
interference  is  always  harmful. 

COLIC 

What  are  the  symptoms  of  colic? 

There  is  a  strong,  hard  cry,  which  comes  sud- 
denly and  returns  every  few  minutes.  With  this 
there  is  drawing  up  of  the  feet,  contraction  of  the 
muscles  of  the  face,  and  other  signs  of  pain.  The 
abdomen  is  usually  tense  and  hard. 

What  should  he  done  for  a  hahy  with  colic? 

First,  see  that  the  feet  are  warm.     Place  them 

against  a  hot-water  bag,  or  hold  them  before  an  open 

fire;  apply  a  hot  fiannel  to  the  abdomen,  or  let  the 

child  lie  upon  its  stomach  across  a  hot-water  bag. 

If  the   colic  continues,   a   half  teacupful   of  warm 
12 


ITS       THE    CARE    AND    FEEDING    OF    CHILDREN 


water  containing  ten  drops  of  turpentine  may  be 
injected  into  the  bowels  with  a  syringe ;  at  the  same 
time  the  abdomtii  should  be  gently  rubbed  so  as  to 
start  the  wind.  If  the  gas  is  in  the  stomach,  half 
of  a  soda  mint  tablet  may  be  given  in  a  tablespoon- 
ful  of  very  warm  water. 

EAEACHE 

What  are  the  symptoms  of  earache? 

The  pain  is  generally  severe  and  accompanied  by 
a  sharp  scream;  the  child  often  puts  the  hand  to 
the  affected  ear,  or  cries  whenever  it  is  touched. 
The  pain  is  likely  to  be  prolonged  and  continuous. 

How  should  a  child  with  earache  he  treated? 

The  ear  should  be  irrigated  with  a  solution  of 
boric  acid  (twenty  grains  to  the  ounce)  as  warm  as 
can  be  borne.  Dry  heat  may  then  be  applied  in 
several  ways.  The  ear  having  been  first  covered 
with  cotton,  a  small  hot-water  bag  or  one  filled  with 
hot  salt  or  bran  may  be  bound  over  it  with  a 
bandage ;  or  a  small  butter  plate  heated  in  hot  water 
may  be  used  in  the  same  way.  The  hot-water  bag 
may  be  held  against  the  ear  or  the  child  may  lie 
with  his  head  upon  it.  The  use  of  such  substances 
as  oil  and  laudanum  in  the  ear  is  not  to  be  recom- 
mended. 


CEOUP  179 

CEOUP 

'   •  What  are  the  symptoms  of  croup? 

There  is  a  hollow,  dry,  barking  cough,  with 
some  difficulty  in  breathing. 

When  is  this  likely  to  come  on? 

Usually  at  night. 

7s  simple  croup  dangerous? 

The  ordinary  croup  of  infants  is  spasmodic 
croup,  and  is  very  rarely  dangerous,  although  the 
symptoms  seem  very  alarming. 

What  are  the  symptoms? 

In  a  mild  attack  there  is  simply  noisy  breath- 
ing, especially  on  drawing  in  the  breath,  with  a 
tight,  barking,  or  croupy  cough.  In  a  severe  attack 
the  child's  breathing  is  more  noisy  and  becomes 
difficult. 

What  is  the  dangerous  form  of  croup? 
Membranous  croup,  which  is  the  same  thing  as 
diphtheria  of  the  larynx. 

How  does  this  develop? 

Gradually;  very  rarely  does  it  come  on  sud- 
denly. 

What  should  he  done  for  a  hahy  who  has  spas- 
modic croup? 

The  room  should  be  very  warm,  hot  clothes  or 


180   THE  CAEE  AND  FEEDING  OF  CHILDEEN 

poultices  should  be  applied  over  the  throat,  and 
-either  a  croup  kettle  or  an  ordinary  tea-kettle  kept 
boiling'  in  the  room.  This  is  more  efficacious  if  the 
child  is  placed  in  a  tent  made  by  a  raised  umbrella 
with  a  sheet  thrown  over  it,  and  the  steam  intro- 
duced beneath  the  tent.  If  the  symptoms  are 
urgent,  ten  drops  of  the  sirup  of  ipecac  should  be 
-given  every  fifteen  minutes  until  free  vomiting 
occurs.  Whenever  the  symptoms  reach  a  point 
^where  breathing  becomes  difficult,  a  doctor  should 
he  summoned  without  delay. 

COI^TAGIOTJS   DISEASES 

What  are  the  first  symptoms  of  measles? 

Measles  comes  on  rather  gradually  with  cough, 
;sneezing,  watery  eyes  and  nose,  much  like  an  ordi- 
nary severe  cold  in  the  head.  The  eruption  appears 
^fter  three  or  four  days,  first  upon  the  face  and 
neck  as  small  red  spots,  and  spreads  slowly  over  the 
body. 

Is  measles  a  serious  disease? 

In  infants  and  during  the  winter  season  it  is 
likely  to  be  very  serious  on  account  of  the  danger 
of  bronchitis  and  pneumonia,  which  frequently  ac- 
company it.  In  children  over  four  years  old  it  is 
.generally  not  severe.    No  child  should  be  voluntarily 


CONTAGIOUS  DISEASES  181 

exposed  to  this  disease,  and  particularly  one  who  is 
delicate  or  prone  to  disease  of  the  lungs  should  be 
protected  against  it. 

When  and  how  is  measles  contagious? 

Measles  may  readily  be  conveyed  from  the  very 
beginning  of  the  catarrh,  two  or  three  days  before 
any  eruption  is  present.  It  is  very  seldom  carried 
by  healthy  persons.  Its  Doison  does  not  cling  long; 
to  a  sick  room. 

What  is  German  measles? 

German  measles,  or  rubella,  is  a  distinct  disease 
and  has  nothing  to  do  with  ordinary  measles.  It  is 
extremely  rare  for  a  child  to  be  very  ill  with  it. 
There  is  usually  a  very  extensive  eruption  which. 
may  cover  the  body,  but  few  other  symptoms. 

What  are  the  first  symptoms  of  scarlet  fever? 

Generally  it  comes  abruptly,  with  vomiting,  high 
fever,  and  sore  throat.  The  eruption  usually  ap- 
pears within  twenty-four  hours  as  a  red  blush,  first 
upon  the  neck  and  chest,  and  spreads  rapidly. 

When  and  how  is  scarlet  fever  contagious? 

Scarlet  fever  is  only  slightly  contagious  for  the 
first  one  or  two  days  of  the  attack.  It  is  most  con- 
tagious at  the  height  of  the  disease  and  during: 
desquamation.     Mild  cases  are  quite  as  contagious- 


182   THE  CARE  AND  FEEDING  OF  CHILDEEN 

as  severe  ones.  In  fact  it  is  by  the  mild  unrecog- 
nized cases  that  the  disease  is  very  often  sj^read. 
It  may  be  carried  by  clothing  or  bedding  from  the 
sick  room  and,  though  infrequently,  by  healthy  per- 
sons ^vho  have  been  in  contact  with  cases. 

How  does  ivJiooping-cougJi  begin? 

For  a  vreek  or  ten  days  it  cannot  be  distinguished 
from  the  cough  due  to  an  ordinary  cold  on  the  chest. 
Then  the  attacks  of  coughing  gradually  become  more 
severe,  especially  at  night,  the  child  gets  red  in  the 
face,  the  eyes  water  with  the  paroxysm  and  vomit- 
ing may  follow.  After  a  severe  coughing  fit  the 
breath  is  caught  with  a  peculiar  noise  known  as  the 
^Vhoop." 

How  does  cMchen-pox  hegin? 

It  usually  comes  out  gradually,  as  widely  scat- 
tered pimples  over  the  scalp,  face,  and  body,  many 
of  which  soon  become  small  vesicles,  resembling  tiny 
blisters  and  afterwards  dry  to  form  crusts.  There 
is  itching  and  local  discomfort  but  little  fever,  and 
the  child  rarely  seems  to  be  very  ill. 

How  does  diplitlieria  hegin? 

Sometimes  suddenly,  but  usually  gradually,  with 
sore  throat  and  swelling  of  the  glands  of  the  neck, 
with  white  patches  upon  the  tonsils,  or  a  free  dis- 
charge, which  may  be  bloody,  from  the  nostrils. 


CONTAGIOUS   DISEASES  183 


How  does  mumps  begin? 
'   -  'As   a  swelling  upon  the  jaw,   just  beneath  the 
ear.      As  it  increases  it  extends  forward  upon  the 
cheek  and  backward  behind  the  ear.     It  may  affect 
one  or  both  sides. 

Mumps  is  not  very  common  in  young  children, 
and  in  them  it  is  usually  mild.  After  twelve  or 
thirteen  years  it  is  likely  to  be  more  severe. 

How  long  after  exposure  do  the  first  symptoms 
appear  in  the  different  diseases? 

in  scarlet  fever  in  from  two  to  five  days,  rarely 
as  late  as  a  week;  in  measles  in  from  nine  to  four- 
teen days,  occasionally  as  late  as  twenty  days;  in 
whooping-cough  in  from  one  to  two  weeks;  in 
chicken-pox  in  from  fourteen  to  sixteen  days;  in 
German  measles  in  from  ten  to  sixteen  days.  In 
diphtheria  the  time  varies  much;  it  may  be  only 
one  day,  and  it  may  be  one  or  two  weeks.  In 
mumps  it  is  usually  a  little  less  than  three  weeks, 
the  average  being  twenty  days. 

Which  of  these  diseases  are  most  contagious? 

Measles  and  chicken-pox  are  very  contagious, 
and  very  few  children  who  have  not  had  them  can 
come  near  a  person  suffering  from  either  disease 
without  taking  it.  Whooping-cough  is  almost  as  con- 
tagious as  measles,  and  for  young  babies  even  more 


184       THE    CAEE    AND    FEEDING   OF   CHILDEEN 

SO.  A  very  close  exposure  is  not  necessary  in  the 
case  of  either  of  these  diseases,  and  whooping- 
congh  can  undoubtedly  be  contracted  in  the  open 
air.  Scarlet  fever  and  diphtheria  are  much  less  con- 
tagious; for  both  of  these  a  pretty  close  exposure  is 
necessary. 

How  long  should  a  child  with  any  of  these  dis- 
eases he  kept  away  from  other  children? 

With  measles,  for  two  v^^eeks  after  the  rash  has 
^one ;  with  scarlet  fever,  for  at  least  four  weeks  after 
the  rash  has  gone,  and  longer  if  the  peeling  is  not 
over  or  if  the  ears  are  running;  with  whooping- 
cough,  for  two  months,  or  so  long  as  the  paroxysmal 
•cough  continues;  with  chicken-pox,  until  all  crusts 
have  fallen  off,  or  for  about  three  weeks  after  the 
•eruption  appears;  with  German  measles  for  one 
week  after  the  eruption  has  faded;  with  diphtheria, 
^t  least  ten  days  after  the  throat  is  well  in  a  very 
m.ild  case,  and  four  weeks  if  the  case  has  been 
severe  or  until  cultures  show  the  throat  to  be  free 
from  the  diphtheria  germs;  with  mumps  for  one 
^week  after  the  swelling  has  gone. 

What  should  he  done  when  a  child  shows  the 
first  symptoms  of  serious  illness? 

The  child  should  be  put  to  bed.  If  it  is  an 
infant,  the  food  should  be  diluted  to  one  half  the 


SCURVY  185 

usual  strength;  if  an  older  child,  only  fluid  food 
should  be  given.  If  the  child  seems  feverish,  take 
the  temperature.  If  the  bowels  are  constipated,  give 
a  teaspoonful  of  castor  oil,  but  no  other  medicine 
without  the  doctor's  orders.  Send  for  the  doctor  at 
once,  and  until  he  comes  carefully  exclude  all  other 
children  from  the  room. 

By  tuhat  nursery  training  may  the  examination 
and  treatment  of  sich  children  he  made  much  easier? 

By  teaching  all  children  to  gargle,  to  show  the 
throat,  to  take  pills,  and  by  constantly  teaching  them 
to  regard  the  doctor  as  the  child's  best  friend,  and 
his  visits  as  a  great  treat.  On  no  account  should  a 
child  be  frightened  into  obedience  by  threats  of  what 
the  doctor  will  do. 

With  care  and  patience  most  children  may  be 
taught  to  gargle  and  take  pills  at  four  or  five  years, 
and  to  show  the  throat  willingly  at  two  or  three. 
All  these  matters  should  be  made  a  part  of  the 
child's  education. 

SCURVY 

What  is  scurvy  and  how  is  it  produced? 

Scurvy  is  a  disease  of  general  nutrition,  usually 
caused  by  the  long-continued  use  of  improper  food. 
Most  of  the  cases  come  from  the  use  of  the  prepared 


186       THE   CAEE   AKD   FEEDING   OF   CHILDEEN 

infant's  foods  sold  in  the  stores,  especially  when 
they  are  given  without  fresh  milk;  occasionally  the 
use  of  condensed  milk  and  of  sterilized  milk  is  fol- 
lowed by  scurvy ;  sometimes  it  is  seen  when,  owing 
to  feeble  digestion,  it  has  been  necessary  to  make 
cow's  milk  very  weak  for  a  long  time. 

What  symptoms  are  seen  in  an  infant  with 
scurvy  f 

At  first  there  is  only  indefinite  and  occasional 
soreness  in  the  legs  so  that  the  child  cries  out  when 
handled.  As  this  soreness  becomes  more  severe  the 
child  is  often  thought  to  have  rheumatism.  The 
gums  swell  and  are  of  a  deep  purple  colour.  There 
may  be  bleeding  from  the  gums,  nose,  bowels,  or 
black-and-blue  spots  may  be  seen  upon  the  legs.  The 
ankles  and  knees  may  swell.  The  child  grows  very 
pale,  loses  appetite  and  weight,  and  sleeps  badly. 

What  should  he  done  when  an  infant  shows  signs 
of  scurvy? 

The  diet  should  at  once  be  changed  to  fresh  milk, 
properly  modified  according  to  the  child's  digestion, 
but  not  sterilized  or  pasteurized.  The  juice  of  a 
sweet  orange  should  be  given,  best  about  an  hour 
before  the  feeding.  ^  At  first  three  or  four  teaspoon- 
fuls,  four  or  five  times  a  day;  later,  more  may  be 
given  if  the  symptoms  are  not  improved. 


CONSTIPATION  187 


Properly  treated  an  infant  with  scurvy  generally 
recovers  promptly  and  completely.  If  not  recog- 
nized, or  "untreated,  it  may  cause  death. 

CON^STIPATION 

When  it  is  necessary  to  move  the  bowels  imme- 
diately,  what  are  some  of  the  easiest  methods? 

An  injection  of  one  tablespoonful  of  sweet  oil 
may  he  given,  or  half  a  teaspoonful  of  glycerine  in 
one  tablespoonful  of  water,  or  a  teacupful  of  tepid 
soap  and  water,  or  a  glycerine  suppository.  ISTone 
of  these  should  he  continued  excepting  under  the 
physician's  directions. 

What  sort  of  a  syringe  is  to  he  preferred  for  giv- 
ing an  injection  to  an  infant? 

The  bulb  syringe  is  the  simplest ;  this  consists  of 
an  oval  bulb  of  soft  rubber  and  a  soft  rubber  or  a 
hard  rubber  tip.     It  holds  one  or  two  ounces. 

What  is  the  most  essential  thing  in  preventing 
or  overcoming  constipation? 

The  formation  of  the  habit  of  having  the  bowels 
move  every  day  regularly  at  the  same  hour,  and 
proper  early  training  (see  page  160). 

What  is  the  test  hour? 

In  most  cases  immediately  after  the  first  meal 
in  the  morning. 


188      THE    CAEE    AND    FEEDING   OF   CHILDEEN 

What  are  some  simple  means  by  which  constipa- 
Hon  may  he  relieved? 

The  best  are  diet,  suppositories,  and  massage. 

The  changes  to  be  made  in  the  milk  of  consti- 
pated infants  have  been  mentioned  on  page  99.  The 
addition  to  the  milk  of  some  of  the  preparations  of 
maltose  mentioned  on  page  66  is  often  nseful.  For 
little  children  the  fruit  juices  are  particularly 
beneficial  when  given  half  an  hour  or  more  before 
the  first  morning  feeding,  with  half  a  glass  of  water. 

For  older  children  the  amount  of  white  bread, 
toast,  and  potato,  should  be  reduced,  and  green  vege- 
tables, oatmeal,  and  Graham  bread  given,  with 
plenty  of  fruit  twice  a  day.  Raw  scraped  apples  are 
sometimes  of  more  value  than  any  other  fruit. 

The  best  suppositories  for  continuous  use  are 
probably  the  gluten  suppositories  of  the  Health 
Food  Company.  One  should  be  given  the  first 
thing  in  the  morning.  They  act  rather  slowly,  usu- 
ally in  about  two  hours.  In  obstinate  cases  one  may 
also  be  used  at  bedtime.  Glycerine  suppositories 
act  more  quickly,  but  are  too  irritating  for  regu- 
lar use. 

Massage  consists  in  rubbing  the  abdomen,  which 
may  be  done  in  one  of  two  ways:  Beginning  at  the 
right  groin,  the  hand  is  carried  up  to  the  ribs,  then 
across  to  the  opposite  side,  then  around  to  the  left 


DIAEEHCEA  189 


groin.  The  abdomen  is  stroked  gently  at  first,  and 
afterward  deeper  pressure  used  as  the  child  becomes 
accustomed  to  it.  The  second  method  is  by  rubbing 
the  deeper  parts  with  a  circular  movement — the 
fingers  not  moving  upon  the  skin — making  a  series 
of  small  circles,  beginning  at  the  right  groin  and 
following  the  same  course  as  described  above. 
Either  method  should  be  employed  for  six  or  eight 
minutes  twice  a  day,  at  almost  any  regular  time, 
except  soon  after  a  meal. 

DIAEEHCEA 

In  case  a  child  is  taken  with  diarrhoea,  what 
should  he  done? 

With  a  moderate  looseness  of  the  bowels  in  an 
older  child,  solid  food  should  be  stopped,  and  boiled 
milk  given  diluted  with  wheat  or  barley  gruel;  the 
child  should  be  kept  in  bed,  as  walking  about  always 
aggravates  such  a  disturbance.  If  the  symptoms  are 
more  severe  and  attended  by  fever  and  vomitings  all 
milk  should  be  stopped  at  once,  and  only  broth, 
barley  water,  or  some  thin  gruel  given.  Some 
cathartic,  usually  castor  oil,  is  required  with  a 
severe  attack.  A  child  of  ^yq  years  should  have 
one  tablespoonf ul ;  it  may  be  given  with  orange 
juice  or  in  soda  water,  never  in  milk. 


190       THE    CAEE   AND    FEEDING   OF   CHILDEEN 

If  the  patient,  is  an  infant,  less  milk  should  be 
used  in  the  formula,  the  sugar  omitted  and  the  fat 
reduced  (see  page  97.)  In  severe  attacks  with 
frequent  foul  stools,  all  food  should  be  stopped  for 
at  least  twelve  hours  and  all  milk  for  a  longer  time, 
and  the  bowels  freely  moved  by  a  cathartic. 

Why  is  a  cathartic  necessary  if  the  movements 
are  already  frequent? 

Such  movements  are  nearly  always  due  to  an 
irritation  in  the  bowel,  set  up  by  the  fermenting 
food  which  has  not  been  digested.  The  diarrhoea 
is  ^N^ature's  effort  to  get  rid  of  the  irritant.  Xothing 
to  stop  the  movements  should  be  given  until  the 
bowels  have  been  thoroughly  cleared  by  the  treat- 
ment mentioned. 

BAD   HABITS 

What  are  the  most  common  had  habits  of  young 
children  ? 

Sucking,  nail-biting,  dirt-eating,  bed-wetting, 
and  masturbation. 

What  do  children  suck? 

Most  frequently  the  thumbs  or  fingers,  some- 
times the  clothing  or  blanket,  often  the  ^^pacifier" 
or  rubber  nipple. 


BAD   HABITS  191 


When  is  this  habit  most  frequently  seen? 

It  begins  in  quite  early  infancy,  and  if  not 
broken  may  last  until  children  are  six  or  seven 
years  old. 

Is  the  sucking  habit  a  harmful  one? 

When  persisted  in  it  may  produce  a  misshapen 
mouth  or  fingers.  It  constantly  stimulates  the  flow 
of  saliva  and  certainly  aggravates  disturbances  of 
digestion  during  which  the  sucking  habit  is  likely 
to  be  practised.  It  may  lead  to  thrush  or  other 
forms  of  infection  of  the  mouth.  It  is  not  necessary 
as  a  means  of  quieting  a  child,  though  it  may  in 
some  degree  cover  up  the  consequences  of  bad  feed- 
ing or  bad  training.  On  no  account  should  the 
habit  of  sucking  the  "pacifier"  be  allowed  as  a 
means  of  putting  children  to  sleep,  or  of  quieting 
them  while  restless  from  dentition  or  indigestion. 

How  is  the  sucking  habit  to  be  controlled? 

One  should  be  sure  in  the  first  place  that  the 
constant  sucking  of  fingers  is  not  due  to  hunger  from 
insufficient  food.  Sucking  of  the  hands  may  often 
be  controlled  by  wearing  mittens  or  fastening  the 
hands  to  the  sides  during  sleep.  In  more  obstinate 
cases  it  may  be  necessary  to  confine  the  elbow  by 
small  pasteboard  splints  to  prevent  the  child  from 
bending  the  arm  so  as  to  get  the  hand  to  the  mouth. 


192       THE    CAEE    AND    FEEDING   OF    CHILDKEN 

When  are  nail-hiting  and  dirt-eating  seen,  and 
how  are  they  to  he  controlled? 

These  habits  belong  especially  to  children  over 
three  years  old.  They  are  seen  particularly  in  those 
who  are  excessively  nervous  or  whose  general  health 
is  below  par ;  sometimes  in  those  who  develop  serious 
nervous  diseases  later  in  life.  Children  with  such 
tendencies  should  be  closely  watched,  and  every 
means  used  to  break  up  these  habits  early.  Dirt- 
eating  is  a  morbid  craving  which  is  rarely  seen  in 
a  normal  child. 

At  what  age  may  a  child  generally  he  expected 
to  go  luithout  wetting  the  hed  during  the  night  f 

Usually  at  two  and  a  half  years,  if  it  is  taken 
up  late  in  the  evening.  Some  children  acquire  con- 
trol of  the  bladder  at  night  when  two  years  old, 
and  a  few  not  until  three  years.  After  three  years 
habitual  bed-wetting  is  abnormal. 

Hoiv  should  a  young  child  addicted  to  hed- 
wetting  he  managed? 

At  three  or  four  years  of  age,  punishments  are 
sometimes  useful,  especially  when  it  seems  to  de- 
pend more  upon  the  child's  indifference  than  any- 
thing else.  They  are  of  no  value  in  older  children, 
rewards  being  much  more  efficacious.  In  all  cases 
one  should  give  a  child  plenty  of  milk  and  water 


BAD   HABITS  193 


early  in  the  day,  but  no  fluids  after  4  p.  m.^  the  sup- 
per, being  always  of  solid  or  semi-solid  food.  The 
child  should  be  taken  up  regularly  at  ten  o'clock  or 
thereabouts.  It  often  happens  that  the  formation 
or  continuance  of  the  habit  is  due  to  the  child  being 
anssmic  or  otherwise  in  poor  general  condition,  to 
some  irritation  in  the  urine,  or  in  the  genital  organs. 
Unless  the  simple  means  mentioned  are  successful 
the  child  should  be  placed  under  the  charge  of  a 
physician. 

What  is  masturhationf 

It  is  the  habit  of  rubbing  the  genital  organs  with 
the  hands,  with  the  clothing,  against  the  bed,  or  rub- 
bing the  thighs  together.  Sometimes  a  child  sits 
upon  the  floor,  crosses  its  thighs  tightly  and  rocks 
backward  and  forward.  Many  of  these  things  are 
passed  over  lightly  and  are  regarded  for  months  as 
simply  a  "queer  trick"  of  the  child.  It  may  be 
seen  at  any  age,  even  in  those  not  more  than  a  year 
old,  and  in  both  sexes. 

How  should  such  a  child  he  treated? 

Masturbation  is  the  most  injurious  of  all  the  bad 
habits,  and  should  be  broken  up  just  as  early  as  pos- 
sible. Children  should  especially  be  watched  at  the 
time  of  going  to  sleep  and  on  first  waking.  Punish- 
ments and  mechanical  restraint  are  of  little  avail 
13 


194   THE  CAEE  AND  FEEDING  OF  CHILDEEN 

except  with  infants.  With  older  children  they 
usually  make  matters  worse.  Rewards  are  much 
more  efficacious.  It  is  of  the  utmost  import- 
ance to  watch  the  child  closely,  to  keep  his  confi- 
dence, and  hy  all  possible  means  to  teach  self-con- 
trol. 

Some  local  cause  of  irritation  is  often  present, 
which  can  be  removed.  Medical  advice  should  at 
once  he  sought. 

VACCINATIOI^ 

Nowadays  when  small-pox  occurs  so  seldom  is  it 
necessary  to  have  every  child  vaccinated? 

It  should  by  all  means  be  done.  It  is  only  by 
the  practice  of  general  vaccination  that  small-pox  is 
kept  down.  In  countries  or  in  communities  where 
vaccination  is  neglected,  frightful  outbreaks  of 
small-pox  occur  every  now  and  then  just  as  in  olden 
times. 

What  is  the  best  time  for  vaccination? 

The  time  usually  selected  is  from  the  third  to 
the  sixth  month.  It  may  be  deferred  in  a  very 
delicate  child  who  is  not  likely  to  be  exposed  to 
small-pox,  or  in  a  child  suffex-ing  from  any  form 
of  skin  di&ease. 


ADENOIDS  195 


Which  is  preferable  for  vaccination^  the  arm  or 
the  leg? 

The  part  which  can  be  most  easily  protected  and 
kept  at  rest  is  to  be  chosen.  In  infants  who  do  not 
yet  walk  or  creep,  the  leg  is  to  be  preferred ;  in  older 
children,  in  most  circumstances,  the  arm.  If  older 
children  are  vaccinated  on  the  leg,  they  should  not  be 
allowed  to  walk  much  while  the  vaccination  is  active. 

When  should  vaccination  he  repeated? 

An  unsuccessful  vaccination  proves  nothing  and 
should  be  repeated  in  two  or  three  weeks.  If  suc- 
cessfully vaccinated  in  infancy,  a  child  should  in- 
variably be  revaccinated  before  puberty.  If  exposed 
or  likely  to  be  exposed  to  small-pox  at  any  time  vac- 
cination should  be  repeated. 

ADENOIDS 

What  are  adenoids? 

The  name  is  given  to  a  lymphatic,  glandular  mass 
which  is  situated  back  of  the  nose  in  the  upper  part  of 
the  throat. 

Do  all  children  have  adenoids? 

They  are  one  of  the  normal  structures  of  the  body. 

Under  what  circumstances  do  they  require  re- 
moval? 

When  they  become  much  enlarged  or  are  the  seat 
of  disease. 


196     THE    CAKE    AND    FEEDING   OF    CHILDEEN 

What  are  the  signs  of  much  enlargement  f 

Mouth  breathing,  restlessness  at  night,  or  snoring 
respiration  during  sleep,  and  in  marked  cases  nar- 
rowing or  sinking  in  of  the  lower  part  of  the  chest, 
owing  to  obstructed  breathing  and  interference  with 
the  general  health  and  normal  growth.  Also,  there 
may  result  a  narrowing  of  the  dental  arch  of  the  up- 
per jaw  leading  to  deformity  of  the  mouth. 

What  are  the  signs  of  diseased  adenoids  ? 

The  most  common  are,  frequently  recurring  acute 
head  colds  or  a  chronic  nasal  discharge,  and  swelling 
of  the  glands  of  the  neck.  There  may  also  be  attacks 
of  earache  or  more  serious  inflammation  of  the  ears, 
resulting  in  abscesses  which  may  discharge  for  a 
long  time. 

Should  all  children  have  adenoids  removed'^ 

When  either  group  of  symptoms  mentioned 
above  are  present  this  should  be  done,  and  if  both 
groups  are  present  removal  is  imperative.  When  none 
of  these  symptoms  exist  operation  is  unnecessary. 

At  what  age  should  the  operation  he  done? 

The  time  of  operation  is  determined  not  so  much 
by  the  age  of  the  child  as  the  urgency  of  the  symp- 
toms. It  may  be  necessary  at  any  age  even  in  an 
infant  under  one  year.  Generally  speaking,  opera- 
tion should  be  deferred  until  the  child  has  passed  the 
age  of  two  or  three  years,  as  the  chances  of  recur- 


ENLAEGED    TONSILS  197 

rence  are  somewhat  less  than  when  the  operation  is 
done  in  infancy. 

Are  adenoids  likely  to  recur  after  removal? 

If  the  operation  is  properly  performed  this  oc- 
curs only  in  a  small  proportion  of  the  cases,  perhaps 
10  or  15  per  cent. 

ENLAEGED    TONSILS 

Under  what  circumstances  should  the  tonsils  he 
removed? 

The  symptoms  requiring  removal  are  much  the 
same  as  those  described  with  adenoids.  The  ton- 
sils should  be  removed  if  they  are  so  large  that  they 
obstruct  respiration,  or  by  inspection  are  seen  nearly 
to  meet  in  the  throat.  Also,  when  they  are  the  seat  of 
chronic  disease.  Often  they  are  ragged,  irregular,  soft 
and  spongy,  although  they  may  not  be  greatly  enlarged. 

Is  it  sufficient  to  amputate  the  tonsils,  or  should 
they  he  completely  removed? 

At  present  surgeons  are  generally  agreed  that  in 
cases  requiring  operation,  the  complete  removal  of 
the  tonsils  is  to  be  preferred. 

Are  there  any  dangers  from  operation  upon  ton'- 
^Is  or  adenoids? 

If  the  operation  is  properly  performed,  the  risk 
is  very  slight  indeed,  but  in  rare  cases  serious  hem- 
orrhage may  occur. 


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INDEX 


14 


INDEX 


Adenoids,  164,  195-197. 
Air,  fresh,  effects  of,  30. 
Airing  the  child,  indoors,  28. 

out  of  doors,  29,  30. 
Airing  the  nursery,  26. 
Albumin  water,  154. 
Alcohol  lamp,  81. 
Anaemic    infants,    beef    juice 

for,  106. 
Appetite,  86. 

lack    of,    food    changes    in- 
dicated by,  103,  104. 

loss  of,  38,  94. 

overfeeding  and,  91. 
Artificial  feeding,  58. 

Band,  abdominal,  22. 
Barley  gruel,  153. 
Barley  jeUy,  153. 
Barley  water,  152. 

use  of,  52,  104. 
Baths,  15,  16. 

bran,  20. 

cold  sponge,  31. 

hot,  for  convulsions,  175. 


Baths,  salt,  20. 

Bed-wetting,  190,  192,  193. 

Beds,  161. 

Beef,  scraped,  152. 

Beef  broth,  151. 

Beef  juice,  150. 

addition  of,  to  milk,  106. 

by  the  cold  process,  150. 
Beverages  for  children,  142. 
"Biliousness,"  133. 
Bottle,    for    children    weaned 
from  the  breast,  54 

preparation    of,    at    feeding 
time,  82. 

weaning  from,  55,  56,  123. 
Bottle-fed    infants,    mortality 

of,  44. 
Bottle-feeding     and     gain     in 
weight,  32. 

combined  with  breast-feed- 
ing, 50. 
"Bottle  habit,"  55. 
Bottles,  feeding,  79,  80. 
Bowels,  in  nursing  mother,  47. 

in  intestinal  indigestion,  104. 


203 


204 


INDEX 


Bowels,   movements   of,   after 
the  first  month,  159. 
dm-ing  first  weeks  of  Hfe,  159. 

regularity  in,   160,   161. 
when    milk    disagrees    with 
child,  50,  51.     (See  also 
Constipation  and  Diar- 
rhoea.) 
Bran  baths,  20. 
Bread,  139. 

dried,  155. 
Breast-fed    infants,    mortality 

of,  44. 
Breast-feeding.    (See  Nm^sing.) 
and    bottle  -  feeding    com- 
bined, 50. 
Breast-milk.     (See  also  Milk, 
mother's.) 
age  for  weaning  from,  53. 
comj)osition  of,  63,  64. 
Broths,  107,  138,  151. 
Bronchitis,  food  in,  103. 
Bunsen  burner,  79,  81. 
Buttermilk,  119. 
Buttocks,  care  of,  20. 

Cake,  139. 

Canned  vegetables,  136. 

Casein  milk,  119,  120. 


Cathartics,  176,  190. 
Centrifugal  cream,  68. 
Cereals,  122,  137,  138. 
Certified  milk,  60. 
Chafing,  19,  20. 
Chest,    average   circumference 
of,    table   showing,    36, 
37. 
Chicken  broth,  151. 
Chicken  pox,  182,  183,  184. 
Circumcision,  17. 
Circumference    of    head    and 
chest,  table  showing  av- 
erage, 36,  37. 
Clothing,  21-23. 

during  airing,  28. 

in  summer,  22. 

in  winter,  23. 
Coddled  egg,  107,  155. 
Cold  sponge  baths,  31. 
Colds,  causes  of,  24. 

food  in,  99. 

in  mother,   nursing  during, 
53. 

prevention  of,  28,  30. 
Cohc,  50,  51,  92. 

in  nursing  infants,  52. 

symptoms  of,  177. 

treatment  of,  98,  177,  178  . 


INDEX 


205 


Composition  of  cow's  milk,  63, 
'    ^^  64. 
of  formulas  from  seven  per 

cent,  milk,  75. 
of     formulas     from     whole 

milk,  73,  74. 
of  mother's  milk,  43. 
Condensed  milk,  108,  116-118. 
(See    also    Milk,     con- 
densed.) 
Constipation,  51, 52,  88, 99, 100. 
chronic,  changes  in  food  in- 
dicated by,  99,  100. 
fruit  juice  for,  100. 
milk  of  magnesia  in,  100. 
treatment  of,  187-189. 
weak  food  and,  88. 
Convulsions,     treatment     for, 

174,  175. 
Cow's  milk.     (See  Milk.) 
Cream,  67,  68. 
Cream  for  older  children,  131, 

133. 
Cream  in  vomiting,  96,  97. 
method  of  obtaining,  68. 
purchased  in  bulk,  61. 
richness  of,  68. 
Cream-dipper,  69. 
Croup,  membranous,  179. 


Croup,    simple  or    spasmodic, 

179. 
Cry,  abnormal,  166,  167 

at  night,  168. 

importance  of,  166. 

normal,  166. 
Curds  and  whey,  152. 

Dentition,  37-39. 

food  in,  103. 
Desserts   for   young   children, 

139,  140. 
Diarrhoea,  treatment  of,   189, 
190. 
use  of  band  in,  22. 
Diet  after  weaning,  56,  57. 
during  third  year,  126,  127. 
for  child  of  12  months,  122. 
from   eighteenth   month   to 
end  of  second  year,  124, 
125,  126. 
from    fourteenth    to     eigh- 
teenth month,  123,  124. 
in  indigestion,  94,  143. 
in     reheving     constipation. 

188,  189. 
of  nursing  mother,  47. 
Digestion,  conditions  influenc- 
ing, 105. 


206 


INDEX 


Diphtheria,  182,  183,  184. 

Diphtheria  of  the  larynx.  (See 
Membranous  croup.) 

Dirt-eating,  190,  192. 

Dressing  and  undressing,  po- 
sition in,  22. 

Dried  milk,  108. 

Ear,  foreign  bodies  in,  177. 

Earache,  178. 

Eczema,  omission  of  tub  bath 

in,  16. 
Egg,  coddled,  107,  155. 
Eggs,  for  older  children,  133, 
134. 

fried,  133. 
Eggs,  idiosyncrasy  to,  134. 
Eggs  not  a  cause  of  "bihous- 

ness,"  133. 
Enlarged  tonsils,  164,  197. 
Exercise,  165. 

for  nursing  mother,  47,  52. 
Eye  teeth,  37. 
Eyes,  care  of,  17,  18. 

Fat,  in  milk,  44. 
Feeding,  artificial,  58. 

at  night,  90. 

before   weaning    an   aid  in 
weaning,  54. 


Feeding,  duration  of,  83. 
during  first  year,  77. 
during  second  year,  121-126. 
during  third  year,  126,  127. 
general  rules  for,  148-150. 
intervals  of,  76-78. 
position     of     child    during, 

83. 
regularity  in,  90,  91. 
rest  after,  84. 
Feeding-bottles,  79,  80. 
Fever,  during  teething,  38. 

in  acute  illnesses,  103,  104. 
Flannels,  23. 
Flatulence,    changes    in    food 

indicated  by,  98,  99. 
Fontanel,  closure  of,  34. 
Food,    changes    in,    indicated 
by    failure    to    gain    in 

weight,  100,  101. 
by  gas  in  the  stomach, 

98. 
by   habitual   flatulence 

and  coUc,  98,  99. 
by  indigestion,  102,  103, 

104. 
by  lack  of  appetite,  104. 
by  serious  acute  illness, 
103. 


INDEX 


207 


Food,    changes    in,    indicated 
'    by  slight  indisposition, 
103. 
by  vomiting  or  regurgi- 
tation, 96. 
increase  in  strength  of,  74, 

75,  85-87,  93,  94. 
increase  in  quantity  of,  85, 

87. 
quantity   of,    factors   deter- 
mining, 70,  71. 
Foreign  bodies  in  the  ear,  177. 

in  the  nose,  177. 
Foreign  bodies  swallowed,  175, 

176. 
Foreskin,  17. 
Formulas,  food,  150-155. 
for  modified  milk,  73,  74. 
from  seven  per  cent,  milk, 

75. 
to  be  used  in  acute  gastric 
indigestion,  103,  104. 
Fresh  air,  effects  of,  30. 
Frozen  milk,  effects  of,  115. 
Fruit  juices,  100,  105,  123,  141. 
Fruits,  during  second  year,  125. 
for  older  children,  141,  142. 
in  diet  of    nursing  mother, 
47. 


Gas  in  the  stomach,  51,  98. 
Gastric  indigestion,  acute, 
treatment  for,  103,  104. 

intervals  of  feeding  in,  78. 
Genital  organs,  cleansing,  16,. 

17. 
German  measles,  181,  183,  184. 
Germs  in  milk,  64,  109,  110 
Goat's  milk,  108,  109. 
Gravies,   135. 
Gravity  cream,  68. 
Gruel,  153,  154. 

for    formulas    from    whole 
milk,  73. 
Guaranteed  milk,  60. 

Habits,  bad,  190-194. 

Head,    average    circumference 
of,  36,  37. 
holding  up,  34. 

Heating  of  nursery,  26. 

Height,    table    showing    aver- 
age, 36,  37. 

Hot  bath,  for  convulsions,  175. 

Hunger  and  weaning,  56. 

Ice,  supply  of,  62. 
Illness,  and  late  sitting,  stand- 
ing or  walking,  35. 


208 


INDEX 


Illness,  immediate  measures  in, 
184,  185. 
of  nm^sing  mother,  53. 
Indigestion,  acute  gastric, 
treatment  for,  103,  104. 
and  reduction  in  food,  88,  89. 
Indigestion  and  teething,   38, 
39. 
in  older  children,  acute,  143, 
144. 
chronic,  143,  145,  147. 
intestinal,  fruits  and,  142. 
increase  in  food  after,  93-94. 
intestinal,  food  changes  in- 
dicated by,  104. 
reduction  of  food  in,  94. 
treatment  of,  102. 
vomiting  a  sign  of,  51. 
Infant  foods  and  weight,  33. 
Injections,  187. 
Intestinal     indigestion,      104, 

142. 
Ipecac  for  croup,  180. 

JelUes,  153,  154. 
Jersey  milk,  58,  93. 
Junket,  152. 

Kissing,  objections  to,  174. 


Laughing,  34. 
Lifting  children,  168,  169. 
Lime  water,  154. 
use  of,  64,  96,  104. 

Magnesia,    milk    of,    for   cop-- 

stipation,  100. 
Malted  milk,  66. 
Maltose,  66. 
in  constipation,   100. 
preparations  of,  66. 
vomiting  aggravated  by,  97. 
Massage   for   relieving  consti- 
pation, 188,  189. 
Mastication,  148. 
Masturbation,  193,  194. 
Meals,  dm'ing  second  year,  121. 
during  third  year,  126. 
from  fourth  to  tenth  year, 
131. 
Measles,  180,  181,  183,  184. 

food  in,  103. 
Meat  pulp,  152. 
Meat,  for  young  children,  134, 

135. 
MeUin's  food,  66. 
Membranous  croup,  179. 
Menstruation,  in  nursing 
mothers)  48. 


INDEX 


209 


Milk,  addition  of  other  foods 

..  to,  105-108. 
boiled,  102,  109. 
bottled,  61. 

care  of,  in  the  home,  60,  61. 
casein,  119,  120. 
certified,  60. 
cleanliness  of,  58,  59. 
condensed,  108,  116-118. 
dried,  108. 
for  children  from  fourth  to 

tenth  year,  131,  132. 
for  children  just  weaned,  56. 
fresh,  59,  60. 
frozen,  115. 
germs  in,  64,  109,  110. 
goat's,  108,  109. 
guaranteed,  60. 
handling,   essentials  in,   59, 

60. 
Jersey,  58,  93. 
malted,  66. 
mixed  or  "herd,"  59. 
modified,  63,  67,  73. 

by  adding  lime  water,  64. 

by  addition  of  sugar,  65, 
66,  67. 

formulas  for,  73,  74,  75. 

in  hot  weather,  100. 


Milk,  mistakes  in,  93,  94. 

of  milk  laboratories,  114, 
115. 
modified,   to  diminish  salts 

and  protein,  67. 
mother's,  affected  by  men- 
struation, 48. 
affected  by  nervous  con- 
ditions, 48. 
compared  with  cow's  milk, 

63,  64. 
composition  of,  43. 
disagreement     of,     with 
child,  symptoms  of,  50, 
51. 
of    magnesia,    in    constipa- 
tion, 100. 
pasteurized,  110. 

preparation  of,  113,  114. 
peptonized,  116. 
preparation    of,    at    home, 
79-82. 
during  second  year,   121, 
122,  123. 
protein,  119,  120. 
purchased  in  bulk,  61. 
quantity  of,  for  older  chil- 
dren, 132. 
richness  of,  68. 


210 


INDEX 


Milk,    selection   and   care   of, 
58-63. 
skimmed,  use  of,  96,  97. 
sterilized,  108,  109-113. 
digestibility  of.  111. 
keeping  of.  111. 
substitutes    for   fresh,    108, 
109. 
temperature  of,  60,  82. 
whole,  formulas  from,  73,  74. 
Milk    sugar,    addition    of,    to 
cow's  milk,  65. 
substitution  for,   in   consti- 
pation, 100. 
Modified  milk.     (See  Milk.) 
MortaHty  of  infants,  44. 
Mother,   nursing,   bowels  and 
digestion  in,  47,  52,  53. 
danger  of  colds  in,  53. 
diet  of,  47,  52,  53. 
effect    of    nervous    condi- 
tions on,  48. 
exercise  for,  47,  52. 
menstruation  in,  48. 
rest  for,  47. 
Mother's  milk.     (See  Milk.) 
Mouth,  cleansing  of,  in  health, 
18. 
in  sprue,  19. 


Mumps,  183,  184. 
Mutton  broth,  151. 

Nail-bitmg,  190,  191. 
Nap,  162. 

Napkins,  care  of,  24. 
Nervous  conditions  in  nursing 

mother,  48. 
Nervousness,  cause  of,  171. 

prevention  of,  171. 
Night,  feeding  in,  90. 
Nipples,  care  of,  46. 

rubber,  79,  80. 
care  of,  80. 
Nose,  foreign  bodies  in,  177. 
Nursery,  airing,  26. 

furnishings  of,  25. 

heating  of,  26. 

temperature  of,  26. 

ventilation  of,  25. 
Nursery  refrigerators,  61. 
Nursing,  diet  of  mother  in,  47. 

duration  of  each,  46. 

during  first  week  of  life,  46. 

favorable  symptoms  in,  49. 

frequency  of,  46. 

importance  of,  during  first 
two  or  three  months, 
45. 


INDEX 


211 


Nursing,  reason  for,  44. 
regularity  of,  46. 
unfavorable    symptoms    in, 

49,  50. 
when  contraindicated,  45. 
Nursing   infants  and   gain   in 
weight,  32. 
vomiting  in,  51. 
Nursing  mother.     (See  Moth- 
er.) 

Oat  gruel  or  jelly,  154. 

Oat  water,  153 

Omelets,  133. 

Orange  juice,   addition  of,   to 

milk,  106. 
Overfeeding,  91,  92. 

Pacifiers,  163,  190,  191. 
Pasteurizers,  113. 
Pasteurizing,  110.  • 

effects  of,  112. 

method  of,  113. 
Pastry,  140. 
Peptonized  milk,  116. 
Peptonizing  powder,  116. 
Playing  with  babies  and  young 
children,  171,  172. 


Pneumonia,  food  in,  103. 
Powder,  use  of,  in  chafing,  19, 
20. 
in  prickly  heat,  21. 
Pregnancy,  a  cause  for  early 

weaning,  53. 
Prickly  heat,  20,  21. 
Protein  in  cow's  milk,  64. 
in  mother's  milk,  43. 
use  of,  44. 
Protein  milk,  119,  120. 
Purees,  139. 
Pus  in  the  eyes,  18. 

Reduction  in  food.,  reasons  for, 
88. 

method  of,  89. 

return  from,  to  original  for- 
mula, 89. 
Refrigerators,  nursery,  61 
Regurgitation,  78,  96. 
Rest  for  nursing  mother,  47. 
Rice  gruel  or  jelly,  154. 
Rice  water,  153. 
Rickets,  35,  38. 

condensed  milk  and,  118. 
Rocking,  162,  163. 
Rubella.      (See  German  mea- 
sles.) 


212 


INDEX 


Rupture,  not  caused  by  cry- 
ing, 168. 

Salads,  137. 

Salt  baths,  20. 

Salt     solution     for     cleansing 

the  eyes,  17. 
Salts  in  cow's  millc,  64. 

in  mother's  milk,  43,  44. 
Scarlet   fever,    181,    182,    183, 

184. 
Schedule    for    feeding    during 
first  year,  77. 
during    second    year,     122, 

124,  125. 
during  third  year,  127. 
Scraped  beef,  152. 
Scurvy,  164,  185,  186. 
condensed  milk  and,  118. 
due  to  artificial  foods,  58. 
sterihzed  milk  and,    112. 
Second  year,   feeding   during, 

121-126. 
Separator,  68. 

Seven  per  cent,  milk,  68,  69. 
(See  also  Top-milk.) 
formulas  from,  75. 
method  of  obtaining,  69. 
Sitting  alone,  34. 


Skimmed    milk,    use    of,    96, 

97. 
Skimming  milk,  68,  69. 
Skm,  care  of,  19-21. 
Sleep,  161,  162,  165. 

disturbed,   163,  164. 
Sleeping,  out  of  doors,  30. 
Sleeplessness,  163. 
Soda,  bicarbonate  of,  in  sprue, 

19. 
Sore  throat,  food  in,  103. 
Soups  for  small  children,  138. 
Sponge  bath,  cold,  31. 
Sponges,  16. 
Sprue,  18,  19. 
Standing  alone,  34. 
Sterilization  of  milk  pails,  bot- 
tles, etc.,  59. 
Sterihzed  milk,  108,  109-113. 
Stomach,  gas  in,  98,  99. 
Stomach  teeth,  38. 
Stools,  appearance  of,  159. 

brown   or   black,    153,    154, 
159. 
Substitutes  for  fresh  milk,  108, 

109. 
Suckmg,   190,   191. 
Sugar,  granulated,  65. 

in  cow's  milk,  C4. 


INDEX 


213 


Sugar,  in  modifying  milk,  67. 

in 'mother's  milk,  43,  44. 
Sugar,    milk,    65.      (See   Milk 
sugar.) 

vomiting  aggravated  by,  97. 
Summer,  clothing  in,  22. 

modifications  in  food. in,  100. 

steriHzed  milk  in,  110. 
Suppositories,  188. 
Sweet  oil  in  chafing,  20. 
Sweets    for    young    children, 

139,  140. 
Syphihs,  164. 

Sjo-inge  for  use  with  infants, 
187. 

Talking,  35,  36. 
Teeth,    first    set    of,    time    of 
appearance   of,   37,   38. 
Teething,  symptoms  of,  38,  39. 

weight  and,  33,  39. 

(See  also  Dentition.) 
Temperature,  for  bathing,  15. 

for  out  of  door  airings,  29. 
Temperature  of  children,  high, 
169,  170. 

in  illness,  170. 

method  of  taking,  170. 

normal,  169. 


Temperature  of  milk,  62. 
testing,  82,  83. 
of  nursery,  26. 
of  refrigerators,  62. 
of    water    for    cold    sponge 
bath,  31. 
for  hot  bath,  175. 
Thermometer,  dairy,  83. 
"Thermos  bottle."     (See  Vac- 
uum bottle.) 
Third    year,    feeding    during, 

126,  127. 
Thrush,  18,  19.. 
Tonsil,  enlarged,  164,  197. 
Top-milk,  definition  of,  68. 
removal    of,     61,    68,    69, 

93. 
seven  per  cent.,  method  of 
obtaining,  69. 
Toys,  first  reaching  for,  34. 
means  of  training,  175. 
selection  of,  172,  173. 
Training,  a  preventive  of  con- 
stipation, 187. 
and  illness,   185. 
in  regular  feeding,  90. 
in  regularity  of  bowel  mover 
ments,  160,  161. 
Tub  bath,  age  for,  15. 


214 


INDEX 


Tuberculosis,  a  contraindica- 
tion to  maternal  nurs- 
ing, 45. 

Underclothing,  in  summer,  22. 
in  cold  weather,  23. 

Vaccination,  194,  195. 
Vacuum  bottle,  uses,  62. 

objections  to,  62. 
Veal  broth,  151. 
Vegetables,  for  small  children, 
135-137. 
canned,  136. 
Ventilation  of  nursery,  26. 
Vinegar  and  wat€r,  use  of,  in 

prickly  heat,  21. 
Vomiting,  76. 
causes  of,  95. 
changes    in   food    indicated 

by,  96,  97. 
changes  in  intervals  of  feed- 
ing indicated  by,  96. 
in  acute  gastric  indigestion, 

103. 
in  nursing  infants,  51,  52. 
in  teething,  38. 
intervals    of    feeding    and, 
77,  78. 


Vomiting,  quantity  of  food  in, 
95. 
symptom     that     milk     dis- 
agrees with  child,  50,  51. 

Walker-Gordon    milk    labora- 
tories,   113,    115. 
Walking,  35. 
Washcloths,  16. 
Water,  boiled,  in  acute  gastric 
indigestion,  103. 
during  first  two  days  of  hfe, 

45. 
during  second  3"ear,  126. 
in  acute  ihness,  103. 
in  hot  weather,  100. 
in  modifying  milk,  67,  72,  73. 
in  mother's  milk,  43,  44. 
in  weaning,  54. 
to  dilute  breast-milk,  52. 
Weaning     from     bottle,      55. 
123. 
age  for,  55. 

delayed,  objections  to,  55- 
method  of,  55. 
from  breast,  age  for,  53. 
diet  after,  56,  57. 
due  to  loss  of  weight,  50. 
early,  reasons  for,  53. 


INDEX 


215 


Weaning  from  breast,  how  to 
overcome  diflBculties  of, 
54. 
in  summer,  54. 
loss  of  weight  at,  32. 
method  of,  54. 
when  milk  disagrees  with 
child,  50,  51. 
Weighing,  frequency  of,  31. 
Weight,  after  weaning,  57. 
at  birth,  33. 

during  first  weeks  of  artifi- 
cial feeding,   87. 
Weight,  failure  to  gain  in,  and 
food,  100,  101. 
treatment  of,  100,  101. 
gain  in,  during  first  year,  32, 
33. 
in  bottle-fed  and  nursing 
infants,  32. 
importance  of,  31. 


Weight  in  second  year,  34. 

overfeeding  and,  92. 

record  of,  31. 

strength  and,  33. 

table   showing  average,  36, 
37. 

teething  and,  33,  39. 

weaning  and,  48,  49. 
Weight  charts,  199,  200. 
Wheat  gruel  or  jelly,  154. 
Wheat  water,  153. 
Whey,  151. 
Whole    milk,    formulas    from, 

73,  74. 
Whooping    cough,    182,    183, 

184. 
Windows  open  at  night,  26. 
Winter,  clothing  in,  23. 

Yolk  of  egg,  grated,  for  infants, 
133. 


(52) 


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